Background and Aims The main goal of this study was to determine the necessity of folic acid supplementation in preterm infants.
Methods Infants born ≤32 weeks of gestation were included in the study with parental consent. Blood samples for the determination of serum folate levels were obtained on days 14 and 28 postnatally, as well as 36 weeks postconceptionally (or just before discharge if patients are discharged before 36 weeks) - samples A, B and C, respectively. Infants were divided into three groups based on mode of feeding; human breast milk (HBM), fortified HBM or preterm formula (PF).
Results A total of 162 preterm infants were enrolled in the study, 17(10.5%) of whom received HBM alone, 94(58%) received fortified HBM and 51(31.5%) were fed with PF. Comparisons between groups revealed that preterm infants in the fortified HBM and PF groups to have significant higher serum folic acid levels in samples C compared to those receiving HBM alone (p<0.001 for both). None of the preterm infants included developed folate deficiency during the study period.
Conclusion This is the largest and most comprehensive clinical study to date evaluating the need for folic acid supplementation in preterm infants who were fed using either modern PFs or milk fortifiers mixed with HBM. Our results suggest that fortified HBM use in preterm infants can alleviate the need for further folic acid supplementation. On the other hand, in preterm infants who are unable to receive HBM folic acid support can be provided with PFs.