Blood Levels of Water-Soluble Vitamins in Pediatric Patients on Total Parenteral Nutrition Using a Multiple Vitamin Preparation

Abstract

Although guidelines for the parenteral use of vitamin preparations in pediatric patients have been published, there are very limited data on the efficiency of these preparations and on the exact needs of infants and children on total parenteral nutrition (TPN). We report here an open, prospective, study of the blood levels of water-soluble vitamins in infants and children on TPN before and during supplementation with a new water-soluble multivitamin formula containing per vial unit: B₁, 3 mg; B₂, 3.6 mg; B₆, 4 mg; niacin, 40 mg; pantothenate, 15 mg; ascorbate, 100 mg; biotin, 60 μg; folic acid, 400 μg; B₁₂, 5 μg. Thirteen children, 9 months to 15 yr old, on home TPN for 1.5 months to 7 yr, and 17 hospitalized infants and children, 1 week to 15 yr old, receiving TPN were studied for 2 weeks to 4 months. Daily doses were given according to age: ½ vial if <18 months; 1 vial if > 18 months and < 10 years; 1.5 vials if >10 years. Assays for B₁, B₂, biotin, niacin, plasma and red blood cell (RBC) folates were performed by microbiologic methods, B₁₂ was measured by radioimmunoassay. During the study, B₁ levels were consistently above the upper limit of the normal range, B₂ and B₁₂ remained in the normal range although there was a slight decrease in B₁₂ values. Almost half of the patients had initially low levels of biotin, niacin, and folates. Biotin, after a significant sharp rise during the first month of supplementation returned to normal range. Niacin levels were initially low in infants and rose toward normal values during treatment. In contrast, teenage patients had niacin levels consistently above normal range before and during the study. Plasma and RBC folate levels had a 3-fold increase during the supplementation. Although the prevalence of abnormal vitamin levels in the hospitalized patients was high, the multivitamin formula appeared adequate to restore normal levels of the surveyed vitamins. However, several elevated values suggest that more studies are needed to define a more precise range of vitamin supplementation in the pediatric population. (Journal of Parenteral and Enteral Nutrition 13:176-184, 1989)