Evaluation of a Pediatric Multiple Vitamin Preparation for Total Parenteral Nutrition in Infants and Children I. Blood Levels of Water-Soluble Vitamins

¹ From the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; Oakland Children's Hospital, Oakland, CA; Baylor College of Medicine, Houston; and University of California, Los Angeles

This study represents the first attempt to evaluate the response to the only intravenous vitamin preparation (MVI Pediatric) for infants and children receiving total parenteral nutrition. Eighteen preterm infants (group 1), 26 term infants and children receiving total parenteral nutrition for 2 to 4 weeks (group 2A), and eight infants and children receiving total parenteral nutrition for 3 to 6 months (group 2B) were studied. Term gestation infants and children up to 11 years of age received daily vitamin doses that approximated the 1974 Recommended Dietary Allowances and coincided with the 1975 American Medical Association Nutrition Advisory Group total parenteral nutrition dosage guidelines for children weighing more than 10 kg. Preterm infants received 65% of these dosages. RBC transketolase (vitamin B₁), glutathione reductase (B₂), and glutamic oxaloacetic transaminase (B₆) activities were maintained at normal levels, and niacin levels were maintained within the reference range (7.1 ± 0.32 µg/mL) in all study patients. Pantothenate, biotin, and ascorbate were maintained at reference levels in groups 2A and 2B. In group 1, ascorbic acid was increased significantly during treatment from 1.53 ± 0.16 to 3.60 by seven days and to 2.54 ± 0.62 by day 28 of treatment (reference normals = 0.99 ± 0.1 mg/dL). RBC folate was maintained within the reference range of 411 ± 76 pg/mL; however, pantothenate and biotin levels increased significantly to more than 2 SD above reference values during treatment, and vitamin B₁₂, levels, which were above the reference range initially, were maintained at more than 2 SD above the reference range throughout treatment. The elevation in vitamin B₁₂ was seen in both group 1 and 2 patients. Overall, the recommended dosages appeared adequate to prevent deficiency; however, the elevated levels of several vitamins in premature infants indicated that further studies should be done to determine more appropriate dosage levels for this group of high-risk patients.

Key Words: multivitamins • total parenteral nutrition • preterm infant • thiamine • riboflavin • pyridoxine • niacin • folate • vitamin B₁₂ • pantothenate • biotin

Submitted on May 28, 1985
Accepted on August 6, 1985

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