Remarks

• The Guideline Development Group acknowledged that vitamin D supplementation is currently recommended within the first weeks after birth as part of national guidance in many countries to improve vitamin D status and prevent rickets; however, there was agreement that, at the present time, there is insufficient evidence on the benefits and harms, if any, of routine vitamin D supplementation on health outcomes of term, breastfed infants.
• Vitamin D supplementation in infants was found to improve 25-hydroxyvitamin D (25(OH)D) concentrations and reduce the prevalence of serum 25(OH)D concentrations < 50 nmol/L.
• However, there was no evidence that vitamin D supplementation in infants reduces the prevalence of serum 25(OH)D concentrations < 30 nmol/L, prevents rickets or improves bone health.
• There was little evidence reported on adverse effects; however, adverse effects would not be expected with daily doses providing the safe and adequate intake level.
• Evidence from non-breastfed infants was not considered by this guideline panel as standards for infant formula include fortification with vitamin D (213).
• In addition to variable acceptability of the intervention across stakeholders, the provision of vitamin D supplements in infants is likely to incur some costs, which does not support its use for all breastfed, term infants.
• It is generally recommended that infants less than 6 months of age be protected from UV rays as much as possible, preferably being kept away from direct sunlight and having their skin protected by appropriate clothing and hats to reduce the risk of skin cancer and adverse effects of excessive sunlight exposure (e.g. sun burn). Phototherapy for the treatment of neonatal jaundice is an exception to this general recommendation.
• Research in this context includes adequately powered studies on the effect of neonatal vitamin D supplementation on mortality, morbidity, growth and development, including clinically relevant outcomes (both benefits and harms), assessment of vitamin D status and cost-effectiveness of this intervention in breastfed and non-breastfed infants.