Published online by Cambridge University Press: 10 December 2009
Vitamins are organic compounds required in trace amounts in the diet for the maintenance of normal growth and development. They are divided into fat-soluble and water-soluble groups. For term infants, the daily requirement is based on the content of human milk with the exceptions of vitamins D and K for which human milk is clearly deficient.
Newborn deficiencies of the fat-soluble vitamins A, D, E and K are well described. The fat-soluble vitamins require the presence of pancreatic enzymes and bile acids in the gut for their absorption. They are stored in the body and thus clinical deficiency may require some time to develop unless stores are inadequate at birth as in the preterm infant. On the other hand, excessive intakes accumulate in the body and have the potential for toxicity. All of the fat-soluble vitamins have been used in pharmacologic quantities in the newborn for treatment or prevention of disease processes, though clear indications for their use in this fashion remain areas of neonatal nutritional controversy. Vitamin D, unique to this family of compounds, functions more like a prohormone in that it can be synthesized in the skin and carried to other organs where the metabolic effects occur.
As for the water-soluble vitamins and vitamin-like cofactors, the same statements cannot be made. Requirements for term infants are based on the concentrations in human milk. Deficiency or toxicity is very rare in developed countries.
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