Dear all:

I will be reading through the detailed information about vitamin D.  As of yet, however, I have seen nothing that suggests to me that there have been any studies to show that there is an improved health outcome from initiating supplementation of an INFANT within 3 days after delivery per the new AAP guidelines.  We know from iron deficiency anemia that there windows when it does and windows when it does not make much of a difference.  One piece of research that was intriguing is that iron status going into pregnancy makes more of a difference than iron supplementation during pregnancy.  This presents a logistical challenge, however, because many women wait until they are pregnant to think about iron stores. 

So, here is an eLetter (read the second letter) about osmolality (basically solute load) and the risks of very early supplementation with vitamin D.  I had been wondering about the same thing myself.  

http://pediatrics.aappublications.org/cgi/eletters/122/5/1142

The other issue is one of adherance. (A while back in the international nutrition realm, we gave up on the term compliance in favor of adherance.  Compliance reminds me of the Borg in Star Trek Next Generation series and apparently many others have similar negative associations with the term "comply".)  A bad experience with supplements, such as severe constipation can keep those who need iron from getting the iron they need because they simply refuse to take it anymore.  Even though theoretically a higher dose would replenish the body faster, sometimes the approach of halving a dose can make it easier and end up with a better nutritional outcome than forcing women to comply with an iron dose that makes them feel ill.

So, in thinking about the most sensitive humans, little newborns with stomachs that are 22-27 mm in capacity, I really cannot imagine any value added from trying to start vitamin D supplementation so early.  I have not yet found a trial that really evaluates the risk in this young of an age group coupled with a direct comparison to infants who are started on supplements at a later age.  

Best regards, 

Susan Burger

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