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Sequential concentrations of copper and ceruloplasmin in serum from preterm infants with rickets and fractures
W W Koo1, P Succop, K M Hambidge
1Department of Pediatrics, University of Cincinnati College of Medicine, OH.
Insights
Preterm infants show a developmental delay in copper and ceruloplasmin metabolism, with levels normalizing by one year. This copper deficiency lag was observed in both preterm infants with and without rickets.
Area of Science:
- Biochemistry
- Neonatology
- Pediatric Nutrition
Background:
- Copper (Cu) and ceruloplasmin are vital for infant development.
- Preterm infants may experience altered nutrient metabolism due to prematurity.
Purpose of the Study:
- To investigate serial serum copper and ceruloplasmin concentrations in preterm infants.
- To compare these levels with healthy term infants and assess potential links to rickets or fractures.
Main Methods:
- Serial measurements of serum Cu and ceruloplasmin in 49 preterm and 21 term infants up to 12 months postpartum.
- Statistical analysis using ANCOVA, controlling for gestational age, birth weight, and nutritional factors.
- Radiographic assessment to identify rickets or fractures in preterm infants.
Main Results:
- Preterm infants exhibited significantly lower serum Cu and ceruloplasmin concentrations up to 6 and 3 months, respectively, compared to term infants.
- Serum Cu and ceruloplasmin levels in all infants increased significantly by 12 months, reaching adult ranges.
- No significant difference in Cu or ceruloplasmin levels was found between preterm infants with or without rickets/fractures.
Conclusions:
- Small preterm infants demonstrate a maturational lag in copper metabolism.
- This lag appears to resolve by one year of age.
- The observed copper and ceruloplasmin changes were not significantly associated with rickets or fractures in this cohort.
Abstract:
Concentrations of copper (Cu) and ceruloplasmin in serum were measured serially in 49 preterm infants with mean (+/- SEM) birth weights of 979 +/- 33 g and gestational ages of 28.4 +/- 0.3 weeks at three, six, nine, and 12 months postpartum. Serial radiographic studies showed 17 infants with (group A) and 32 infants without (group B) rickets or fractures. Cu and ceruloplasmin concentrations in serum also were measured in 21 healthy term infants (group C) with birth weights 3668 +/- 98 g at three, six, and 12 months postpartum. Analyses of covariance of serial changes in these serum variables--taking into account such potential covariates as differences in gestational age, birth weight, initial weight and length, changes in weight and length during the study, the duration of parenteral nutrition, and increased enteral copper intake--showed both groups of preterm infants had significantly lower concentrations of Cu in serum up to age six months and ceruloplasmin up to age three months (P less than 0.001) when compared with term infants. By one year of age, Cu and ceruloplasmin concentrations in serum in all groups had increased significantly (P less than 0.001), into the adult range, and were not significantly different among groups. These data document a maturational lag in copper metabolism in small, preterm infants. Changes in concentrations of Cu and ceruloplasmin in serum were significantly correlated (r = 0.92, P less than 0.001) but were not significantly different between preterm infants with and without rickets or fractures at each age.