Vitamin A
The infant depends exclusively on the mother for its vitamin A supply. Because the infant’s liver stores can only be replenished during pregnancy, they depend on the mother’s supply. If women take in too little vitamin A during pregnancy, an adequate supply for the newborn cannot be guaranteed due to low vitamin A stores. The newborn’s liver stores only last for a few days and are quickly depleted, for example, after infections that increase vitamin A consumption or in the event of absorption disorders. It is therefore important for the mother to ensure an adequate vitamin A intake even during breastfeeding.The level of vitamin A concentration in the milk also depends on the mother’s diet. If women have consumed sufficient vitamin A during pregnancy, the vitamin A content in breast milk for mature babies is ensured and additional supplementation of the newborn is not necessary.In breastfed premature babies, supplementation with 200-1000 µg of vitamin A per day is recommended because the plasma concentration of the active vitamin A form retinol as well as of retinol binding protein (RBP) in the umbilical cord blood is lowered. Substitutions with vitamin A increase the plasma concentration of vitamin A in infants and prevent chronic lung diseases Newborns not fed with breast milk should receive a carotenoid complex of 1-2 milligrams as prophylaxis [4.2. ].However, the values should not be exceeded, because overdoses – more than 100,000 µg – can cause vomiting and increase the infant’s intracranial pressure. Function of vitamin A
- Necessary for the maintenance of skin, cell membranes, and skeletal tissues
- Plays an important role in spermatogenesis (sperm cell formation), androgen and estrogen synthesis
- Key component for the visual process and color vision
- Growth and organ formation controlled by retinoids formed from vitamin A
- Antioxidant protection
- Maintenance of immune function
- Iron transport
- Erythropoiesis (red blood cell/erythrocyte formation)
- Myelin synthesis in the nervous system
Sources: Contained in animal foods – liver, butter, cheese, boiled eggs, pasteurized milk, herring.
Vitamin D
The need for vitamin D is particularly increased in infants when the mother has not consumed enough in her diet during pregnancy and thus has insufficient reserves. Because vitamin D can be synthesized in the human body when exposed to light, the infant’s need is also increased if women have had little sun exposure during pregnancy and levels in breast milk are correspondingly low. In addition, newborns have low UV-B exposure during the first months of life, which further increases the requirement [4.2. ].The vitamin D content in the plasma of the newborn is always lower than the mother’s plasma vitamin D level because of the low content of vitamin D-binding proteins. If, as a result, the mother’s blood level of vitamin D is too low after birth, infants are at extreme risk of deficiency.In addition, only low concentrations of the vitamin are found in the mother’s milk – usually 0.1-0.2 µg – which makes it necessary to substitute the newborn with about 10 µg of vitamin D. The mother’s blood level of vitamin D is too low after birth. Supplementation can help prevent manifest rickets or osteomalacia.Industrially produced infant milk is also fortified with 10 µg of vitamin D. However, since vitamin D from ready-milk foods is less easily absorbed by the newborn, an additional 12.5 µg is administered orally.Infants born before the 32nd week of pregnancy have a higher vitamin D requirement than mature infants. Premature infants require approximately 800-1600 IU for osteoporosis prevention and other purposes [1.2. ].Reasons for increased requirements in premature infants compared with mature infants:
- Stronger growth
- Possess a lower vitamin D storage
- The biological transformation pathway of vitamin D is not yet fully developed
- Deficiency of bile acid and low fat intake limit intestinal vitamin D uptake
Function of vitamin D
- Prerequisite for a functioning bone metabolism
- Affects the absorption of calcium and phosphorus
- Regulates the calcium and phosphate balance
- Insulin secretion
- Cell growth
- Maintenance of the immune system
Sources: Contained in animal foods – egg, meat, fish, cheese, butter, milk Vitamin D supplements must not be overdosed in infants under any circumstances, as heart defects, brain damage, lung diseases as well as failure to thrive may result
Vitamin E
Newborns have very low vitamin E stores. This is due to low vitamin E transport from the placenta to the fetus. Especially in premature infants, plasma vitamin E levels are low at the time of birth. The earlier a child is born, the lower its vitamin E levels [4.1. ].Via breast milk, the only marginal vitamin E levels can be replenished within a few weeks. Vitamin E supplementation is thus not necessary in newborns, since the vitamin E content of breast milk – if the mother’s reserves are sufficient – is sufficient to supply the infant.However, if infants are not breastfed and are fed on homemade cow’s milk mixtures, a substitution of about 2 to 3 milligrams of alpha-tocopherol equivalents per day must be made to protect the newborn from deficiency symptoms. Function of vitamin E
- As an essential antioxidant for unsaturated fatty acids, it protects lipid membranes from damage by oxygen radicals
- Prevents proliferation of free radicals by interrupting their chain reactions
- Protects cholesterol from oxidation and thus prevents atherosclerosis (arteriosclerosis, hardening of the arteries)
- Suppression of oxidation of phospholipids and arachidonic acid in the cell membrane – prevention of rheumatic diseases.
- Increases the production of cellular and humoral defenses, so that immune function is improved
- Increases resistance to bacteria
Sources: Contained in vegetable oils, wheat germ oil, peanuts, whole grains, leafy vegetables For tumor prevention, vitamin E can be substituted together with antioxidant vitamin C and beta-carotene. To enhance the effect, the addition of other antioxidants is recommended.
Vitamin K
Because of inadequate vitamin K uptake from the mother as well as the lack of vitamin K production in the fetal intestine, which is not yet colonized by bacteria, newborns have low plasma vitamin K levels. Due to the low vitamin K concentration, the synthesis of coagulation factors is significantly reduced. As a result, neonates have low levels of plasma coagulation proteins – decreased prothrombin levels, which drop to 20-40% of the adult norm by the third day after birth. In addition, infants have a prolonged prothrombin time – 19-22 seconds, normal 13 seconds.For this reason, babies often have a high bleeding tendency, which can lead to cerebral hemorrhage in addition to gastrointestinal bleeding [1.2. ].Vitamin K administration to the mother via venous access – parenterally – before birth does not provide any benefits because immature infants can synthesize the missing clotting factors in only minimal amounts. Parenteral administration to the mother may even increase the already elevated bilirubin concentration in the blood of the newborn (hyperbilirubinemia) and result in jaundice. On the other hand, there is nothing to be said against oral substitution in the last week of pregnancy.Vitamin K substitutions to infants are extremely helpful, since in this way the synthesis of coagulation factors and thus the prothrombin levels can be increased, as well as a prolongation of the prothrombin time can be prevented. All newborns should receive 0.5-1 milligrams of water-soluble vitamin K intramuscularly or orally as prophylaxis on the first day of life, and the dosage should be given weekly until full oral nutrition is achieved. Parenteral administration is also recommended for premature infants, as well as for infants with impaired vitamin K absorption – in cystic fibrosis, chronic diarrhea, and hepatitis.Breast milk contains only 1-2 µg of vitamin K, resulting in daily supplementation of breastfed infants with 2-3 µg per kilogram of body weight.Unsupplemented newborns are at increased risk for bleeding disorders – hemorrhagic diseases – with increased risk of mortality. In particular, cerebral hemorrhage may occur in premature infantsVitamin K function
- Involvement in the synthesis of coagulation factors.
- Important function in the bone system – controls the activity of bone-forming cells – osteoblasts – thus essential for bone health
Sources: Contained primarily in plant foods – spinach, broccoli, lettuce, Brussels sprouts, cauliflower; medium levels in meat, offal and fruit; low levels of vitamin K in milk and cheese
Vitamin B complex including biotin and folic acid
Usually, when the mother’s supply of the B vitamins is good, no deficiency is described in premature and mature infants fed on breast milk. Under normal circumstances, breast milk thus contains sufficient amounts of vitamins B1, B2, B3, B5, B12, as well as biotin. The mother’s need for these B vitamins and biotin is increased during lactation, but does not exceed that during pregnancy. Substitution does not appear to be appropriate either for the mother or for breastfed premature or mature infants [1.2]. Supplementation is also not necessary in newborns fed fortified formula. It is important that the B vitamins are adequately supplied in combination, since each B vitamin can develop its respective effect only in association with the others Daily requirement of the mother during lactation:
- Vitamin B1 – 1.5-1.7 mg.
- Vitamin B2 – 1.6-2.2 mg
- Vitamin B3 – 17-20 mg
- Vitamin B5 – 2.5-5.0 mg
- Vitamin B12 – 4.0 µg
- Folic acid – 600 µg
- Biotin – 20-30 µg
However, if women take too small amounts of the vitamins during pregnancy, in addition to the deficiency of the mother, there is also an undersupply of the baby. Since vitamin B1 is sensitive to heat, it can be quickly lost in the preparation of ready-milk food. Infants fed with boiled milk should therefore be substituted with 1-2 milligrams of vitamin B1 as a precautionary measure.Vitamin B2, on the other hand, is extremely sensitive to light. If infants are treated with phototherapy to reduce hyperbilirubinemia, they may quickly develop a mild riboflavin deficiency. Vitamin B2 cannot withstand ultraviolet rays. If the mother has sufficient dietary vitamin B2, the infant can also be well supplied and there is no need to substitute the infant with riboflavin. Marginal deficiencies of the newborn can thus be corrected by the vitamin B2 content in the mother’s milk. Vitamin B6The vitamin B6 supply of breast milk-fed infants depends on the mother’s vitamin B6 intake. If women pay attention to a high vitamin B6 intake already during pregnancy, the pyridoxine concentration in breast milk is sufficient.Under normal circumstances, the content of breast milk decreases from 47 µg per dl on the second and third day of breastfeeding to 23 µg per dl during the first month of lactation.Vitamin B6 is better stored in the body of breastfed preterm infants than in those fed with formula milk. This is due to the higher bioavailability of vitamin B6 from breast milk. Non-breastfed infants have a correspondingly higher requirement due to the lower bioavailability from formula milk.The pyridoxine requirement in premature infants varies greatly, as it depends on the respective protein intake. The higher the protein intake, the higher the vitamin B6 requirement, since the vitamin acts as a coenzyme in amino acid metabolism. A daily vitamin B6 intake of 100-300 µg is recommended for premature infants.Insufficient pyridoxine intake by the mother is associated with low plasma vitamin B6 concentrations in the infant, as the concentration in breast milk decreases. If a child is at risk of deficiency, a generous substitution of between 10 and 27 milligrams per day appears to be eminently reasonable Note!No vitamin B6 monopreparation should be used for substitution, since the vitamins of the B group act only in combination [4.1. ].Function of vitamin B6.
- Coenzyme in protein, carbohydrate and fat metabolism of more than 60 enzymes.
- Ensures cellular and humoral immune defenses
- Glycogenesis
- Hemoglobin synthesis
Sources: Occurrence especially in wheat germ, fish, meat, liver, egg yolk, nuts, whole grain products, rice, beans and avocado Vitamin B12If women do not neglect their vitamin B12– intake within pregnancy, the serum concentration of the newborn is usually 2-3 times higher than that of the mother.Women with a vegetarian diet or with a deficiency of intrinsic factor, which is essential for the absorption of vitamin B12, on the other hand, show considerable vitamin B12 deficiencies without supplementation. In such circumstances, vitamin B12 administration is urgently needed to avoid putting the child’s health at risk [4.2]. Folic acid – also known as vitamin B9Because folic acid is an extremely heat-labile and light-sensitive vitamin, it is quickly lost in high amounts during food storage or preparation. Therefore, a deficiency can quickly develop in the mother. Young breastfeeding women between the ages of 18 and 24 are particularly at risk of deficiency because they do not take in enough folic acid through food. Consequently, insufficient amounts in breast milk mean that the newborn cannot be optimally supplied with folic acid. Folic acid substitution is urgently needed, with mature infants receiving about 100-200 µg. In particular, premature infants are found to have an increased requirement due to the small amount of endogenous reserves and rapid growth after birth. Because of this, premature infants are substituted with a maximum of 65 µg of folic acid per day.If milk substitute formula cannot be fortified with 40 µg per dl for technical reasons, newborns not fed with breast milk should also be supplemented with about 65 µg of folic acid. A mature and fully breastfed infant does not need to be supplemented because he or she takes in about 60 µg of folate with 750 milliliters of breast milk per day [1.2. ].With an adequate folic acid intake, optimal cell proliferation and tissue regeneration can be ensured in the growing child, and the normal stock of blood cells can be maintained [4. Under normal circumstances, the folic acid content of breast milk increases from 0.5-1 µg per dl to 2-4 µg per dl during the first month after birth and to 5-10 µ per dl by the third month. Because folic acid in milk is protein-bound to beta-lactoglobin, vitamin B9 from breast milk is best absorbed by the infant, in contrast to formula milk. Function of folic acid
- DNA synthesis
- Protein biosynthesis
- Homocysteine degradation
- Formation of erythrocytes (red blood cells), amino acids and nucleic acids
- Essential for cell division and formation, reproduction and growth [1.2].
- Importance in nerve metabolism
Sources: Occurrence in leafy vegetables, asparagus, tomatoes, cucumbers, cereals, beef and pork liver, chicken egg yolk, and walnuts – Folates from animal products are often better absorbed than folates from plant products
Vitamin C
Because vitamin C is heat labile and readily oxidizes in aqueous solutions, optimal dietary vitamin C intake usually cannot be guaranteed. Consequently, vitamin C concentrations are too low in many lactating women as well as in their breast milk, necessitating a substitution of about 100-200 milligrams. The vitamin C reserves of the premature infant are relatively high, which means that deficiency in the form of scurvy rarely occurs [1.2. ].If premature infants are not fed with breast milk but with casein-rich ready-mixed milk foods, they have increased levels of tyrosine and phenylalanine and their metabolites in plasma and urine due to the reduced activity of the enzyme tyrosine aminotransferase. In this case, premature infants should receive daily supplementation of 50-100 milligrams of vitamin C.It is also advisable to prophylactically substitute breastfed newborns – about 20 milligrams of vitamin C daily – because up to 90% of vitamin C is lost when breast milk is pasteurized. Without any treatment, breast milk contains about 4 milligrams of vitamin C. Function of vitamin C
- Strong reducing agent
- Involved in electron transport of hydoxylation reactions.
- Cofactor in carnitine synthesis
- Antioxidant protection, inactivation of oxygen radicals, prevents lipid peroxidation.
- Detoxification of toxic metabolites and drugs
- Prevents the formation of carcinogenic nitrosamines
- Important for collagen biosynthesis
- Conversion of folic acid into the active form (tetrahydrofolic acid).
- Regenerates vitamin E when exposed to radicals, increases iron absorption.
- Improves the ability of muscles to burn fat for the purpose of energy production
- Essential for the biological activity of hormones of the nervous system, such as TRH, CRH, gastrin or bombesin.
- Immunoregulatory
Sources: Vitamin C content is particularly high in freshly picked fruits and vegetables – rose hips, sea buckthorn juice, currants, peppers, broccoli, kiwi, strawberries, oranges, red and white cabbage Carnitine must be additionally substituted in case of high vitamin C deficits [4.1. ].Table – Need for vitamins.
| Vital substance (micronutrients) | Deficiency symptoms – effects on the mother | Deficiency symptoms – effects on the infant |
| Vitamin A |
Increased risk of
Overdoses lead to
|
Overdoses at intakes of more than 1 million IU per day lead to malformations of various degrees, such as.
|
| Vitamin D | Loss of minerals from bones – spine, pelvis, extremities – leads to.
|
Overdoses lead to
|
| Vitamin E |
|
|
| Vitamin K | Blood coagulation disorders leading to
Decreased activity of osteoblasts leads to.
|
|
| Vitamin B6 |
|
|
| Folic acid | Mucosal changes in the mouth, intestines, and urogenital tract lead to
Impaired formation of white blood cells leads to.
Elevated homocysteine levels increase the risk for
Neurological and psychiatric disorders, such as.
|
Disturbances in DNA synthesis-restricted replication-and decreased cell proliferation increase the risk for
|
| Vitamin C |
|
Increased risk of vitamin C deficiency disease – Möller-Barlow disease in infancy with symptoms such as.
|
