Flavin adenine dinucleotide levels in erythrocytes of very low birthweight infants under vitamin supplementation.

Despite the potential dangers of over- and undersupplementation with riboflavin (vitamin B2), little is known about status, requirements and metabolism of this vitamin in very low birthweight (VLBW) infants. As reported here, it is possible to calculate the intraerythrocytic concentration of free flavin adenine dinucleotide (FAD), the predominant coenzyme form of riboflavin, on the basis of the erythrocyte glutathione reductase activation coefficient (EGRAC). This parameter was determined in 9 VLBW infants (median of birthweight 634 g, median of gestational age 24 weeks + 3 days) at intervals over a period of 6 weeks. All infants received riboflavin supplementation, either in milk (average intake: 175 micrograms/kg/day) and a multivitamin preparation (200 micrograms/day) or via total parenteral nutrition (TPN; 720 micrograms/kg/day). The average EGRAC was 1.07 (1.00-1.24) during enteral nutrition and 1.05 (1.00-1.18) during TPN. These values correspond to free FAD levels of 757 and 1,060 nM, which is 4 to 5 times higher than in cord blood or in breast-fed infants. EGRAC values between 1.15 and 1.35, representing free intracellular FAD levels of 350-150 nM, should be adequate in VLBW infants in order to minimize the hazards of flavin-induced radical reactions.