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Improved bone mineral status in very low birthweight infants fed human milk mixed with preterm formula
Insights
Very low birthweight infants exclusively fed mother's milk often develop phosphorus deficiency. Supplementation with phosphorus and calcium is crucial to prevent metabolic bone disease in preterm infants.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Mineral Metabolism
Background:
- Very low birthweight (VLBW) infants are at high risk for bone mineral deficiencies.
- Exclusive human milk feeding, while beneficial, may not provide adequate phosphorus (P) and calcium (Ca) for bone mineralization in VLBW infants.
- Metabolic bone disease of prematurity is a significant concern in this vulnerable population.
Purpose of the Study:
- To compare the bone mineral status of VLBW infants fed exclusively mother's milk versus a mixed diet of mother's milk and preterm formula.
- To evaluate the efficacy of a preterm formula enriched with phosphorus and calcium in preventing bone demineralization.
Main Methods:
- A comparative study involving two groups of VLBW infants.
- Group I: exclusively fed mother's milk.
- Group II: fed mother's milk initially, followed by a 1:1 mixture of mother's milk and preterm formula high in P and Ca.
Main Results:
- Most infants in both groups exhibited biochemical signs of phosphorus deficiency by week 4.
- Group II infants showed improved serum P levels and decreased alkaline phosphatase (ALP) activity compared to Group I.
- Group II had a lower incidence of severe radiographic bone abnormalities at 12 weeks.
Conclusions:
- Exclusive human milk feeding in VLBW infants necessitates phosphorus and calcium supplementation.
- A preterm formula enriched with phosphorus and calcium can help prevent metabolic bone disease of prematurity.
- Early biochemical and radiographic evidence supports the need for targeted mineral supplementation in VLBW infants.
Abstract:
The bone mineral status of very low birthweight (VLBW) infants fed exclusively their own mother's milk (group I) was compared with that of VLBW infants fed mother's milk in the initial 4 weeks followed by a 1:1 mixture of mother's milk and preterm formula containing high phosphorus (P) and calcium (Ca) (group II). In both groups, most infants showed a biochemical picture characteristic of phosphorus deficiency syndrome by the fourth week. Thereafter, serum alkaline phosphatase activity (ALP) decreased and serum P increased in all group II infants. Conversely, serum ALP rose and hypophosphatemia persisted in most group I infants. Group II had a significantly higher serum P at weeks 8 and 12 and a significantly lower ALP at week 12 than group I. Furthermore, group II had a lower incidence of severe radiographic abnormalities than group I at week 12. We confirmed previous observations that VLBW infants fed exclusively human milk require P and Ca supplementation to prevent metabolic bone disease of prematurity.