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Plasma and Urine Riboflavin During Riboflavin-Free Nutrition in Very-Low-Birth-Weight Infants

BackgroundVery-low-birth-weight (VLBW; birth weight <1500 g) infants receive enteral and parenteral nutriture that provides greater daily riboflavin (vitamin B2) than does term infant nutriture, and elevated plasma riboflavin develops in these infants after birth. The purpose of this study was to measure plasma and urine riboflavin concentrations in VLBW infants during riboflavin-free nutrition. Our hypothesis was that elevated plasma riboflavin develops in VLBW infants because of high daily intake and immature renal riboflavin elimination. MethodsEighteen clinically healthy VLBW infants received parenteral nutrition and preterm infant formula during the first postnatal month. On postnatal days 10 and 28, the infants received specially prepared riboflavin-free enteral and parenteral nutrition for the 24-hour study period. Serial collections of plasma were made at time 0 and at 12 and 24 hours. Urine was collected continuously for the 24-hour period in 4-hour aliquots. Samples were analyzed for riboflavin concentration. ResultsDuring the 24-hour riboflavin-free study period on postnatal day 10, plasma riboflavin decreased 56% from 185 ± 37 ng/mL (mean ± SEM), and urine riboflavin decreased 75% from 3112 ± 960 mg/mL. Similarly, on postnatal day 28, plasma riboflavin decreased 79% from 184 ± 32 ng/mL, and urine riboflavin concentration decreased 91% from 5092 ± 743 ng/mL during the 24-hour riboflavin-free study period. Riboflavin half-life (t½) was 18.5 hours on postnatal day 10 and decreased 48% by postnatal day 28. Riboflavin elimination was 145.1 ± 20.6 mg/kg per day on postnatal day 10 and increased 40% by postnatal day 28. ConclusionThe VLBW infants who received parenteral nutrition and preterm infant formula had elevated plasma riboflavin on postnatal days 10 and 28. Plasma riboflavin t½ was shorter and renal riboflavin elimination was greater on postnatal day 28 than on postnatal day 10. Plasma riboflavin was normal after 24 hours of riboflavin-free nutrition. The pattern of plasma and urine riboflavin in VLBW infants suggests a lower daily intake would maintain plasma riboflavin close to normal.