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A.S.P.E.N. clinical guidelines: nutrition support of neonatal patients at risk for metabolic bone disease
Deepika Nehra1, Sarah J Carlson, Erica M Fallon
1Department of Surgery and The Vascular Biology Program, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Premature infants face risks of metabolic bone disease. This guideline addresses maternal factors, feeding strategies, vitamin D, and parenteral nutrition to improve neonatal bone health.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Metabolic Bone Disease
Background:
- Premature infants are highly susceptible to metabolic bone disease, leading to impaired bone growth, osteopenia, and rickets.
- Early identification and management are crucial for preventing long-term skeletal complications.
Purpose of the Study:
- To provide evidence-based recommendations for managing metabolic bone disease in at-risk neonates.
- To address key questions regarding risk factors, nutrition, vitamin D supplementation, and parenteral nutrition.
Main Methods:
- A systematic review of existing evidence was conducted.
- Recommendations were developed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) concepts.
- A consensus process informed guideline development and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors.
Main Results:
- Identified maternal risk factors contributing to neonatal metabolic bone disease.
- Evaluated optimal enteral and parenteral nutrition strategies for bone health.
- Provided guidance on vitamin D administration timing and dosage.
- Assessed the role of parenteral nutrition in metabolic bone disease and offered formulation recommendations.
Conclusions:
- Optimizing nutrition and timely interventions are key to preventing and managing metabolic bone disease in premature infants.
- The guideline offers practical strategies for clinicians caring for at-risk neonates.
Background:
Premature infants are at increased risk for metabolic bone disease, with resulting delayed bone growth, osteopenia, and rickets.
Method:
A systematic review of the best available evidence to answer a series of questions regarding neonatal patients at risk of metabolic bone disease receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors.
Questions:
(1) What maternal risk factors predispose the neonate to metabolic bone disease? (2) What is the optimal type of feeding to promote neonatal bone health? (3) When and how should vitamin D supplements be administered? (4) Does parenteral nutrition (PN) predispose a neonate to metabolic bone disease, and if so, are there PN formulation recommendations to minimize this risk?
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