Remarks

• The GDG noted that the evidence on harms (increased mortality) was uncertain due to low-certainty evidence and imprecision.
• The recommendation is conditional on shared decision-making with parents; this includes informing parents about the benefits and risks and the need for further research.
• The GDG also noted improvements in vitamin D deficiency and alkaline phosphatase levels but there were no data on other markers of bone health such as osteopenia or rickets.
• The GDG noted that there were limited data on the dose, timing of initiation and duration of supplementation. Based on most trials included in the evidence review, the GDG suggests a daily dose of 400–800 IU may be initiated when enteral feeds are well established, and may be continued until the infant receives vitamin D from another source.