The use of choline supplementation in premature newborns: a systematic review

Rodrigues LM, et al. The use of choline supplementation in premature newborns: a systematic review. 2025 Aug 8;43:e2024214. doi:10.1590/1984-0462/2025/43/2024214

Objective: To identify the routes and doses of choline supplementation required to meet the metabolic demands of preterm infants.

Data source: The information was searched in three databases: US National Library of Medicine National Institute of Health (PubMed), Scientific Electronic Library Online (SciELO) and Web of Science. The search for articles was updated in August 2024, with no restrictions on publication year or language. This review was registered in the International Prospective Register of Systematic Reviews - PROSPERO (ID: 549568).

Data synthesis: The final selection of studies yielded eight original articles, which were subsequently evaluated for their methodological quality. The recommended dosage of parenteral choline remains uncertain. However, studies have demonstrated a reduction in serum choline level inversely proportional to the quantity administered via parenteral nutrition, particularly in preterm infants with slow progression to enteral nutrition. The dose of 40-50 mg/kg/day of enteral choline appears to be sufficient to maintain plasmatic levels at a concentration comparable to that observed in the umbilical cord of preterm infants.

Conclusions: The need for daily choline supplementation from the first day of life is still controversial. The results of the selected studies do not allow for the determination of the optimal choline dosage for parenteral nutrition in these infants. Nevertheless, there is some scientific evidence suggesting that providing 40-50 mg/kg/day enterally is sufficient to meet the metabolic needs of preterm infants.