The effect of folinic acid supplementation on homocysteine concentrations in newborns

Abstract

Objective: The incidence of cerebrovascular accidents (CVA) occurring perinatally is relatively high and aspects of the multifactorial pathophysiology remain unclear. Elevated homocysteine concentrations have been shown to be associated with an increased risk for CVA in children and even in newborns. We studied the possible homocysteine lowering effect of folinic acid in newborns. Method: We included 37 newborns in our prospective randomized folinic acid (given as 5-formyltetrahydrofolate) intervention study from patients admitted to our neonatal intensive care unit (18 controls, 19 intervention group). We measured total homocysteine (tHcy) and plasma folate concentrations at three time points (baseline, 1 and 2 weeks after intervention). The intervention group was treated with folinic acid (70 mg/kg/day) for 2 weeks. We calculated median concentrations (25th and 75th percentiles). Results: Median tHcy concentrations at the three time points did not differ from each other in the control group nor in the intervention group. We also could not observe different tHcy concentrations between both groups. Plasma folate concentrations increased in the intervention group (mean increase 167% (95% confidence interval (CI) À291, 625)) compared with control group (mean increase À12% (95% CI À132, 108)), P for treatment effect: 0.03. Conclusion: We could not demonstrate a homocysteine lowering effect of folinic acid administration in newborns. This indicates that one carbon metabolism in newborns differs form adults. Cobalamin might be a better strategy to lower tHcy concentrations in newborns.

Neonatal folate, homocysteine, vitamin B12 levels and methylenetetrahydrofolate reductase variants in childhood asthma and eczema

“…Also, studies in adults showed that folate supplementation reduced homocysteine levels in those with the TT genotype more than those with CC or TC genotype . However, in newborns, homocysteine levels were not affected by an increased folate, suggesting that homocysteine metabolism and response to folate is different in newborns, as compared with adults . In addition, we found that the effect of MTHFR C677T on folate metabolism is also different in newborns.…”

Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency

“…This represents the 97.5 percentile in 4 months old infants given a single intramuscular dose of 400 μg hydroxocobalamin at 6 weeks, rendering them to be cobalamin optimized (Bjørke-Monsen et al, 2008 ). In addition, administration of folinic acid in newborns did not reduce tHcy (Hogeveen et al, 2010 ). In older children and adults, tHcy is mainly a folate marker, while MMA is considered a good marker for cobalamin status (Bjørke Monsen and Ueland, 2003 ; Monsen et al, 2003 ).…”

Folic Acid, Folinic Acid, 5 Methyl TetraHydroFolate Supplementation for Mutations That Affect Epigenesis through the Folate and One-Carbon Cycles

“…In addition, the recommended dose greatly exceeded the normal “folates” requirement of 500 to 800 µG per day in adults. FLA does not decrease plasma homocysteine levels in newborns who are at risk of ischemic and hemorrhagic stroke due to elevated Hcy [ 27 ]. FLA is rarely used in pathologies of reproduction/embryogenesis; however, its positive effect on counteracting the well-known deleterious effects of valproic acid on embryogenesis is controversial.…”