Clinical inquiries. What vitamins and minerals should be given to breastfed and bottle-fed infants?

■ Evidence summary Vitamin K. The Cochrane Database of Systematic Reviews looked at randomized trials to determine the effectiveness of vitamin K prophylaxis in preventing classic hemorrhagic disease of the newborn. Two trials demonstrated that a single dose of intramuscular vitamin K reduced clinical bleeding at 1 to 7 days. Oral vitamin K has been studied for its effects on biochemical indices of coagulation status, but not for its clinical effects on bleeding. A single oral vitamin K dose at birth resulted in lower vitamin K levels at 2 weeks and 1 month, compared with a single dose of intramuscular vitamin K at birth. Iron. The iron status of exclusively breastfed infants vs formula-fed infants was evaluated in a nonrandomized cohort study. Twenty-five healthy, breastfed infants and 15 healthy infants fed highiron formula were followed for 9 months. No differences in mean hemoglobin values were seen at any age between the 2 groups. A randomized controlled trial investigated the efficacy of daily and weekly iron supplementation on iron status in 67 Breastfed and formula-fed infants should receive intramuscular vitamin K soon after birth to prevent classic hemorrhagic disease of the newborn (strength of recommendation [SOR]: A, systematic review of controlled trials). Routine iron supplementation for all term, healthy, breastfed infants is not proven to be safe or necessary. Formula-fed infants should be consuming formula that contains 10 to 12 mg/L of iron (SOR: A, 2 small randomized controlled trials). Healthy, term infants at the highest risk for vitamin D deficiency are those who are breastfeeding and have dark skin or little sun exposure (SOR: B, 2 case series). Infants consuming at least 500 mL of fortified formula each day do not need additional supplementation. A recommendation of vitamin D supplementation of 200 IU/day should be explained to all families, particularly those at highest risk for nutritional rickets (SOR: C, expert opinion). Infants older than 6 months should receive an oral fluoride supplement of 0.25 mg if they consume fluids with a water fluoride level less than 0.3 ppm (SOR: B, poorquality randomized controlled trials). Anne Eglash, MD Department of Family Medicine, University of Wisconsin Medical School, Madison