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Calcium and phosphorus balance of extremely preterm infants with estradiol and progesterone replacement
Andreas Trotter1, Ludwig Maier, Frank Pohlandt
1Section of Neonatology and Pediatric Critical Care Medicine, Children's Hospital, Ulm, Germany.
Insights
Hormone replacement therapy with estradiol (E2) and progesterone (Prog) did not improve calcium (Ca) and phosphorus (P) retention in extremely premature infants. This pilot study suggests E2 and Prog replacement is not beneficial for mineral retention in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pediatric Nutrition
Background:
- Extremely premature infants miss crucial placental supply of estradiol (E2) and progesterone (Prog).
- This hormonal deprivation may impact mineral homeostasis, specifically calcium (Ca) and phosphorus (P) retention.
- Understanding these effects is vital for optimizing nutritional support in preterm neonates.
Purpose of the Study:
- To investigate the effect of E2 and Prog replacement on Ca and P retention in extremely premature infants.
- To determine if hormonal support can enhance mineral absorption and retention in this population.
- To inform potential therapeutic strategies for improving bone health in preterm neonates.
Main Methods:
- A randomized controlled pilot study involving 20 female infants (mean gestational age 26.6 weeks).
- One group received E2 and Prog replacement to mimic intrauterine levels; the control group did not.
- Calcium and Phosphorus balance studies were conducted when formula intake reached at least 100 mL/kg/d.
Main Results:
- The E2 and Prog replacement group showed mean Ca retention of 4.21 mMol/kg/d (58% of intake) and P retention of 2.66 mMol/kg/d (80%).
- The control group exhibited mean Ca retention of 3.39 mMol/kg/d (56% of intake) and P retention of 2.03 mMol/kg/d (71%).
- No statistically significant improvement in Ca and P retention was observed with E2 and Prog replacement.
Conclusions:
- Hormone replacement therapy with E2 and Prog did not enhance Ca and P retention in extremely premature infants in this pilot study.
- The findings suggest that E2 and Prog replacement may not be an effective strategy for improving mineral retention in this population.
- Further research is needed to fully elucidate the role of these hormones in preterm infant mineral metabolism.
Abstract:
Infants born extremely prematurely are deprived of the placental supply of estradiol (E2) and progesterone (Prog) at an earlier developmental stage compared to an infant born at term. We hypothesized that the retention of Ca (calcium) and P (phosphorus) would be improved by an E2 and Prog replacement. Twenty female infants with a mean gestational age of 26.6 weeks (+/-1.5 SD) and a mean birth weight of 744 g (+/-156) were enrolled in a randomized controlled pilot study. One group received an E2 and Prog replacement to maintain intrauterine plasma concentrations of E2 and Prog and the other group served as control. When intake of formula was at least 100 mL/kg/d, a 3-day Ca and P balance study was performed. Ca and P intake was increased individually until both elements were excreted in the urine. The mean Ca and P retention was 4.21 (+/-1.75) mMol/kg/d (58% of intake) and 2.66 (+/-1.01) mMol/kg/d (80%) in the replaced group and 3.39 (+/-1.69) mMol/kg/d (56%) and 2.03 (+/-0.79) mMol/kg/d (71%) in the control group, respectively. In this pilot study the retention of Ca and P was not improved by an E2 and Prog replacement.