Micronutrient supplementation in low-birth-weight and very-low-birth-weight infants

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Micronutrient supplementation in low-birth-weight and very-low-birth-weight infants

Intervention | Last updated: 9 August 2023

Every year, more than 20 million infants are born weighing less than 2.5 kg – over 96% of them in developing countries. These low-birth-weight (LBW) infants are at increased risk of early growth retardation, infectious disease, developmental delay and death during infancy and childhood. Very-low-birth-weight (VLBW) infants - those infants born weighing less than 1.5 kg - are particularly vulnerable to the these adverse outcomes.

Most LBW and VLBW is a consequence of preterm birth, small size for gestational age, or both.

Interventions to improve the feeding of LBW and VLBW infants are likely to improve the immediate and longer-term health and well-being of the individual infant and have a significant impact on neonatal and infant mortality levels in the population.

LBW infants, particularly VLBW infants, are frequently deficient in one or more micronutrients, which may impact normal growth and development. Supplementation with certain micronutrients may therefore reduce the risk of some complications associated with LBW and VLBW.

WHO Recommendations

The recommendations below do not address sick infants or infants with birth weight less than 1.0 kg. Recommendations for VLBW infants specifically address those infants with birth weight between 1.0 and 1.5 kg.

Daily oral vitamin A supplementation for LBW infants who are fed mother's own milk or donor human milk is not recommended at the present time, because there is not enough evidence of benefits to support such a recommendation.

Routine zinc supplementation for LBW infants who are fed mother's own milk or donor human milk is not recommended at the present time, because there is not enough evidence of benefits to support such a recommendation.

VLBW infants should be given vitamin D supplements at a dose ranging from 400 IU to 1000 IU per day until 6 months of age.

VLBW infants who are fed mother’s own milk or donor human milk should be given daily calcium (120–140 mg/kg per day) and phosphorus (60–90 mg/kg per day) supplementation during the first months of life.

VLBW infants fed mother’s own milk or donor human milk should be given 2–4 mg/kg per day iron supplementation starting at 2 weeks until 6 months of age.

IU = international unit