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Results of extremely-low-birth-weight infants randomized to receive extra enteral calcium supply
William F Carroll1, Jorge Fabres, Tim R Nagy
1Miami Children's Hospital, Miami, Florida, USA.
Insights
Extra calcium supplementation did not improve bone mineral content or prevent head shape changes and myopia in extremely-low-birth-weight infants. Decreased phosphorus excretion suggests potential phosphorus deficiency with calcium supplementation.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Bone Metabolism
Background:
- Extremely-low-birth-weight (ELBW) infants often experience bone mineral deficiency.
- Standard enriched formulas may not fully prevent these deficiencies.
Purpose of the Study:
- To investigate if additional enteral calcium (Ca) supplementation increases bone mineral content (BMC).
- To determine if Ca supplementation prevents dolichocephalic head flattening and myopia in ELBW infants.
Main Methods:
- Randomized controlled trial involving ELBW infants (401-1000g birth weight).
- Infants received either standard feeds or feeds supplemented with Ca-gluconate.
- Outcomes measured included urinary Ca and phosphorus excretion, head shape (FOD/BPD ratio), BMC, and refractive error.
Main Results:
- Ca supplementation increased urinary Ca excretion and decreased phosphorus excretion.
- No significant differences were observed in total BMC between supplemented and control groups.
- Head shape and refractive error at follow-up also showed no significant differences.
Conclusions:
- Extra enteral Ca supplementation did not enhance BMC or prevent head shape abnormalities or myopia in ELBW infants.
- Reduced phosphorus excretion may indicate a potential phosphorus deficiency, counteracting bone mineral accretion benefits.
Background And Objective:
Bone mineral deficiency continues to occur in extremely-low-birth-weight (ELBW) infants despite formulas enriched in calcium (Ca) and phosphorus (P). This study tested whether extra enteral Ca supplementation increases bone mineral content (BMC) and prevents dolichocephalic head flattening and myopia in ELBW infants.
Study Design:
Infants 401 to 1000 birth weight receiving enteral feeds were randomized to receive feeds supplemented with Ca-gluconate powder or pure standard feeds. The main outcome measures were the excretion of Ca and P by weekly spot urine measurements, the degree of dolichocephalic deformation (fronto-occipital diameter to biparietal diameter ratio, FOD/BPD) at 36 weeks postmenstrual age, and the BMC (by dual-energy x-ray absorptiometry) at discharge. Cycloplegic refraction was measured at 18 to 22 months corrected age.
Patients And Results:
Ninety-nine ELBW infants with a gestational age of 26 weeks (23-31) (median [minimum-maximum]) were randomized at a postnatal age of 12 days (5-23) weighing 790 g (440-1700). Urinary Ca excretion increased and P excretion decreased in the Ca-supplemented group. Total BMC was 89.9 ± 2.4 g (mean ± SE) in the supplemented group and 85.2 ± 2.6 g in the control group (P = 0.19). The FOD/BPD was 1.50 (1.13-1.69, mean ± SD [standard deviation]) and 1.47 (1.18-1.64) in the supplemented and control groups, and the refraction 0.98 ± 1.23 and 1.40 ± 1.33 dpt (P = 0.68), respectively in 64 ELBW infants (79% of survivors) at 2-year follow-up.
Conclusions:
Extra enteral Ca supplementation did not change BMC, head shape, or refraction. The decreased P excretion may reflect P deficiency in infants receiving extra Ca, preventing improved bone mineral accretion.
