Infant folic acid

Folic acid supplementation with 1 mg daily generally is recommended in adult SCD patients, women considering pregnancy, and any SCD patient with chronic hemolysis.6 Because of accelerated erythropoiesis, these patients have an increased need for folic acid. There are conflicting studies in the SCD population, especially among infants and children, but if the child has chronic hemolysis, supplementation is recommended.21... 

The fact that certain human adults or infants develop types of anemia which respond to small doses of folic acid can be interpreted to mean that, for reasons which doubtless have some genetic basis, these individuals have unusually high demands for this vitamin. Presumably they develop the disease when consuming diets that do not induce the disease in others. Folic acid needs are (for one reason or another) highly variable from individual to individual among patients as is shown by the fact that many patients will respond to as little as 0.5 mg. folic acid per day, whereas others will not respond at all... 

Deficiency of folic acid is a common nutritional problem of worldwide importance.13 A recommended daily intake is 0.2 mg, but because of the association between low folic acid intake and neural tube defects in infants, women of child-bearing age should have 0.4 mg / day.c e... 

Tanner, J.T., Barnett, S.A., and Mountford, M.K. 1993. Analysis of milk based infant formula. Phase V. Vitamins A and E, folic acid, and pantothenic acid Food and Dairy Administration-Infant Formula Council Collaborative study. J. AOAC Int. 76 399-401. 

BT Jacoby, FT Henry. Liquid chromatographic determination of folic acid in infant formula and adult medical nutritionals. J AOAC Int 75 891-898, 1992. 

It is estimated that the minimum daily requirement of folate is 5 micrograms/kg. Liver stores are about 160 micrograms in premature children, and 220 micrograms in full-term infants. Infants who require parenteral nutrition will rapidly become folate deficient unless fohc acid is included in the regimen. Since many multivitamin supplements do not contain folic acid, its inclusion should be ensured by the addition of folic or folinic acid. 

Neural tube defects, characterized by a failure of the neural tube to close properly after conception, affect about one in 1000 live births in the USA. Periconceptional folic acid supplementation reduces the risk. To determine whether periconceptional exposure to folic acid antagonists might therefore increase the risk of neural tube defects, data from a case-control study of birth defects (1979-98) in the USA and Canada have been examined (14). Data on 1242 infants with neural tube defects (spina bifida, anencephaly, and encephalo-cele) were compared with data from a control group of 6660 infants with malformations not related to vitamin supplementation. Triamterene is a folic acid antagonist and in this series was associated with the development of neural tube defects, but there were too few cases to estimate an odds ratio. 

An early review of newer case reports and placebo-controlled trials involving several hundred patients did not show an increase in fetal abnormalities (176). However, the relative risks of cardiovascular defects and oral clefts in infants whose mothers were exposed to dihydrofolate reductase inhibitors, such as trimethoprim, during the second or third month after the last menstrual period, compared with infants whose mothers had no such exposure, are 3.4 (95% Cl = 1.8, 6.4) and 2.6 (1.1, 6.1) respectively (177). Multivitamin supplements containing folic acid reduced the adverse effects of dihydrofolate reductase inhibitors. There have been two reports of severe spinal malformations in the fetuses of HIV-positive women treated with combination antiretroviral therapy and co-trimoxazole (178). 

L9. Luhby, A. L., Eagle, F. J., Roth, E., and Cooperman,. M., Relapsing megaloblastic anemia in an infant due to a specific defect in gastrointestinal absorption of folic acid. Am. 

Anemia has frequently, but not consistently, been reported in association with scurvy in clinical cases, both in adults and infants, and in experimental scurvy in guinea pigs and monkeys. The extensive literature has been cited (M18, L19, V2). The anemias were not constant in type or severity, although all were reheved when ascorbic acid was reintroduced to tbe diet. In contrast, no anemia or abnormality of the blood picture was ever seen in experimental human scurvy. The therapeutic effect of ascorbic acid on the anemia cannot be accepted as proof of its etiology, since associated deficiencies would also be made good with the return of normal appetite. It is well recognized that the clinical cases of scurvy usually have associated deficiencies. Often, there is iron deficiency in the milk-fed infants, and folic acid or vitamin B12 deficiency in the malnourished adult. ... 

De Brouwer et al. (2010) identified 5 folate vitamers in their study 5-methyltet-rahydrofolate (the predominant vitamer), 5,10-methenyltetrahydrofolate and tetrahy-drofolate (the most labile vitamers), folic acid, and 10-formyl folic acid. This study reported that folate levels in wild-type rice were approximately 20 pg/lOO g lower than in bio-fortified rice [41], While separation of folate vitamers was obtained in 8 min run time, a previous LC-MS/MS method required 20 min [49]. Also, UPLC improved the sensitivity by reducing the limit of quantitation. Another study documented that endogenous 5-methyltetrahydrofolate in bread ranged between 1.3 and 3.4 pg/100 g [14]. Measurements of folic acid and 5-methyltetrahydrofolate in flour and infant milk formula have been successfully made using this method, described in the latter study. 

The UPLC-MS/MS method has also been developed for fast simultaneous separation and determination of 14 different water-soluble vitamins and vitamin-like compounds in infant formula (thiamine, riboflavin, pantothenic acid, nicotinic acid, nicotinamide, pyridoxine, pyridoxal, biotin, fohc acid, cyanocobalamin, ascorbic acid, L-camitine, choline, and taurine) [91], Methotrexate was also used as an internal standard for riboflavin, cyanocobalamin, biotin, and folic acid, while nicotinamide was used as an internal standard for the other compounds. 

Folic deficiency was thought to be rare in humans, but more and more cases of deficiency were reported as the methods for diagnosis improved. It is now sometimes assumed to be one of the most common vitamin deficiencies. In humans, megaloblastic anemia develops after five months of administration of a folic acid-deficient diet, suggesting that it takes that long to deplete the body of its folic acid reserves or sources. The exact human requirements for folic acid are unknown, but it is estimated that 50-250 pg of folic acid is required daily in adults and 5-20 pg in infants. These figures are based on the hematological response observed in patients with folic acid deficiency. 

In the mid-twentieth century, pediatric care often began with a newborn examination shortly after birth. As of 2011, pediatric care often begins before conception. Women are advised via media sources or a health care provider to prepare for pregnancy and improve the chances for a healthy infant. This advice includes smoking cessation and supplementing the diet with folic acid, which decreases the incidence of neural tube defects, such as spina bifida. 

Jung, M., Kim, B., Boo, D.W., and So, H.-Y., 2007. Development of isotope dilution-liquid chromatography/tandem mass spectrometry as a candidate reference method for the determination of folic acid in infant milk formula. Bulletin of the Korean Chemical Society. 2007 745-750. 

Malatack JJ, Moran MM, Moughan B. Isolated congenital malabsorption of folic acid in a male infant insights into treatment and mechanism of defect. Pediatrics 1999 104 1133-1137... 

In an analysis of data from the Mother and Child Cohort study in Norway, where foods are not fortified, wheezing and lower respiratory tract infections during the first 18 months of life were examined in 32 077 children born between 2000 and 2005 in relation to maternal reported intake of folic acid 400 mg/day and cod liver oil 5 ml/day [29 , 30" ]. The relative risks in the infants of mothers who took folate supplements during the first trimester were 1.06 (95% Cl = 1.03, 1.10) for wheezing, 1.09 (95% Cl = 1.02, 1.15) for lower respiratory tract infections, and 1.24 (95% Cl = 1.09, 1.41) for hospitalization associated with lower respiratory tract infections. Although small, these relative risks were statistically significant. 

Knowledge of metabolic pathways of phenylalanine and tyrosine has been obtained by study of certain inborn errors of metabolism in man (see Chapter 5). Of particular interest in human nutrition is the relationship of ascorbic acid and folic acid in the metabolism of these two amino acids. In premature infants or in persons with scurvy, the feeding of high protein diets or the administration of tyrosine leads to hydroxyphenyluria. Both ascorbic acid and folic acid (large doses) will prevent the excretion of abnormal quantities of hydroxyphenyl derivatives. Recently, Sealock... 

Folic Acid—Ascorbic Acid Relationships. Folic acid and ascorbic acid have some interesting metabolic relationships, among which is a role in tyrosine metabolism. Abnormal excretion of tyrosine metabolites occurs in human infants with scurvy, and in premature infants when the diet is high in this amino acid. Folic acid, in large doses, will prevent or relieve this abnormal excretion, as does ascorbic acid. Folic acid exerts a similar action in scorbutic guinea pigs. ... 

The spontaneous occurrence of megaloblastic anemia in association with infection in infants and in monkeys is described by May ei al. (1952a,b). The low content of folic acid compounds in the liver in both natural and experimental infections and the elimination of megaloblasto-sis from the marrow by folic acid, but not by vitamin Bij or ascorbic acid, led to the conclusion that infection can cause a deficiency of folic acid compounds. 

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