The 2008 revised American Academy of Pediatrics (AAP) recommendation for 400 IU/day vitamin D intake makes progress toward achieving infant vitamin D sufficiency in the United States. Further study, however, is needed both to define vitamin D sufficiency for preterm infants based on markers of vitamin D biologic function and to develop supplementation strategies to ensure adequate vitamin D intake and, thus, vitamin D sufficiency in this at-risk population. In this review, we highlight some of the issues surrounding vitamin D status of the neonate and the particular risks for the preterm infant. We review the evidence regarding the impact of vitamin D deficiency in this population and the safety and efficacy of vitamin D supplementation. Based on previous study in preterm infants, the current AAP guidelines to achieve serum 25-hydroxyvitamin D [25(OH)D] status of at least 50 nmol/L and to receive at least 400 IU/day are safe and possibly adequate. Because of the nutritional difficulties in achieving consistent delivery of 400 IU/day of vitamin D in the preterm infant, it is imperative to devise strategies for close monitoring of each preterm infant's vitamin D status and consider oral vitamin D supplementation as an important adjunct to dietary sources and multivitamin preparations.

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