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Published on: January 29, 2018
Diet, growth, and bone mineralization in premature infants
J Faerk1, S Petersen, B Peitersen
1University Clinic of Pediatrics, Hvidovre Hospital, Copenhagen, Denmark.
Insights
Premature infants require high nutrient intake for optimal growth. Supplementing human milk with protein, calcium, and phosphate showed a trend toward improved growth and bone mineralization compared to unsupplemented milk.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Metabolic Bone Disease
Background:
- Premature infants have elevated energy, protein, and mineral needs.
- Inadequate nutrition increases risks for poor growth and metabolic bone disease.
- Optimizing nutritional support is critical for preterm infant development.
Purpose of the Study:
- To evaluate the impact of different nutritional strategies on growth and bone mineralization in premature infants.
- To compare outcomes of human milk supplementation versus unsupplemented human milk or preterm formula.
- To assess the effectiveness of fortifying human milk with protein, calcium, and phosphate.
Main Methods:
- Double-blind study of 127 premature infants (gestational age < 32 weeks).
- Randomization into three feeding groups: supplemented human milk, fortified human milk, or unsupplemented human milk/preterm formula.
- Weekly measurements of linear growth (knemometry) and head circumference; DEXA-scan for bone mineralization and body composition at term.
Main Results:
- A trend towards slower growth and lower bone mineral content was observed in infants fed unsupplemented human milk.
- The differences in growth and bone mineralization between supplemented/fortified human milk and unsupplemented groups were not statistically significant.
- Infants fed fortified human milk (protein, calcium, phosphate) showed a tendency for better outcomes.
Conclusions:
- While unsupplemented human milk may lead to slightly reduced growth and bone mineralization in preterm infants, the differences were not significant in this study.
- Fortification of human milk with protein, calcium, and phosphate appears beneficial, warranting further investigation.
- Nutritional strategies for premature infants require careful consideration to meet their high metabolic demands.
Abstract:
Energy, protein, and mineral requirements in premature infants are high, hence increasing the risk of poor growth and development of metabolic bone disease. This double-blind study included 127 consecutive premature infants with gestational age below 32 weeks. Both sick and healthy infants participated. Average duration of ventilator treatment: 2 days, CPAP treatment: 10 days (range, 0-50d). Infants were randomized to 3 groups from 1 week old to 37 weeks of gestational age and fed the following: a) human milk (their own mother's milk or banked milk) supplemented with phosphate, b) human milk fortified with protein, calcium, and phosphate, or c) unsupplemented mother's milk or preterm formula. Infants randomized to preterm formula were fed formula only if their own mother's milk was not available, hence there were 2 subgroups of infants fed either unsupplemented human milk or preterm formula. Volume of intake was 191+/-14mL/kg/d (mean +/- SD); linear growth was measured weekly by knemometry; head circumference was measured weekly; and growth rate was calculated by linear regression for each infant. Bone mineralization and body composition were measured by DEXA-scan (Hologic 1000/W) at term. There was a tendency toward slower growth and less bone mineral content in infants fed unsupplemented human milk but, surprisingly, the difference was small and not significant.
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