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Early high calcium and phosphorus intake by parenteral nutrition prevents short-term bone strength decline in preterm
L Pereira-da-Silva1, Ab Costa, L Pereira
1Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal. l.pereira.silva@netcabo.pt
Insights
Higher early calcium and phosphorus intake via parenteral nutrition helps prevent bone strength decline in preterm infants. This nutritional strategy supports bone health in vulnerable newborns during the critical early weeks after birth.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Bone Metabolism
Background:
- Very premature newborns face high risks of low bone mass and metabolic bone disease.
- Longitudinal studies indicate a significant decline in bone strength in early neonatal periods.
- Parenteral nutrition (PN) is crucial for nutrient delivery in preterm infants.
Purpose of the Study:
- To determine if higher early calcium (Ca) and phosphorus (P) intake via PN can prevent bone strength decline in preterm infants.
- To assess the impact of different Ca doses on bone strength in the initial weeks post-birth.
- To evaluate the efficacy of optimized parenteral mineral supply for neonatal bone health.
Main Methods:
- A randomized controlled trial involving neonates born at ≤ 33 weeks gestational age.
- Infants received either low-dose (LD) Ca 45 mg·kg⁻¹·day⁻¹ or high-dose (HD) Ca 75 mg·kg⁻¹·day⁻¹ via PN.
- Bone strength assessed by speed of sound (SOS) using quantitative ultrasound, with low bone strength (SOS < 10th centile) as the primary outcome.
Main Results:
- Eighty-six infants were enrolled; 40 in LD and 46 in HD groups.
- In the HD group, SOS values remained stable from birth, unlike the LD group.
- Low bone strength was significantly less frequent in the HD group compared to the LD group up to six weeks.
Conclusions:
- Early parenteral administration of Ca 75 mg·kg⁻¹·day⁻¹ and P 44 mg·kg⁻¹·day⁻¹ effectively prevents short-term bone strength decline in preterm infants.
- Optimized early mineral intake through PN is a viable strategy to support bone development in extremely preterm neonates.
- This study highlights the importance of precise nutritional management for neonatal bone health.
Background And Aim:
Very premature newborns have an increased risk of low bone mass and metabolic bone disease. Most longitudinal studies report a significant decline in bone strength in the first weeks after birth. The aim of the study was to evaluate whether higher early calcium (Ca) and phosphorus (P) intake delivered by parenteral nutrition (PN) can prevent bone strength decline in preterm infants, within the first weeks after birth.
Patients And Methods:
This was a randomized controlled trial of consecutively admitted neonates born with ≤ 33 weeks of gestational age, assigned to receive either Ca 45 mg · kg⁻¹ · day⁻¹ (low dose [LD]) or Ca 75 mg · kg⁻¹ · day⁻¹ (high dose [HD]) by PN. P was added to the PN solutions at a fixed Ca:P ratio (mg) of 1.7:1. Bone strength was assessed by the speed of sound (SOS) using the quantitative ultrasound method. Measurements were performed weekly from birth until discharge. Low bone strength (SOS < 10th centile of reference values) was the main outcome.
Results:
Eighty-six infants were enrolled, 40 assigned to LD group and 46 to HD group. Mean (standard error) gestational age was 29.6 weeks (2.1) and birth weight was 1262 g (0.356). In the HD group, the SOS values never fell below those recorded at birth and, up to the sixth week of life, low bone strength was significantly less frequent as compared with that in the LD group, in spite of progressive reduction in parenteral mineral intake and/or establishment of full enteral feeding.
Conclusions:
Early assigned parenteral intake of Ca 75 mg · kg⁻¹ · day⁻¹ and P 44 mg · kg⁻¹ · day⁻¹ significantly contributed to preventing short-term bone strength decline in preterm infants.
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