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Hypophosphatemia in breast-fed low-birth-weight infants following initial hospital discharge
R T Hall1, R E Wheeler, M B Montalto
1Section of Neonatal Medicine, Children's Mercy Hospital, University of Missouri, Kansas City School of Medicine.
Insights
Low-birth-weight infants fed human milk are at risk for hypophosphatemia after hospital discharge. Early vitamin D supplementation during hospitalization may prevent this condition in vulnerable infants.
Area of Science:
- Neonatal Nutrition
- Pediatric Endocrinology
Background:
- Low-birth-weight infants (<2000 g) require careful nutritional management post-discharge.
- Human milk is often the preferred feeding for these vulnerable infants.
- Potential nutrient deficiencies in human milk for preterm infants are a concern.
Purpose of the Study:
- To evaluate the risk of hypophosphatemia in low-birth-weight infants fed human milk versus cow's milk formula.
- To identify potential risk factors and preventive strategies for hypophosphatemia in this population.
Main Methods:
- A comparative study of 12 low-birth-weight infants fed human milk with supplements and 20 fed cow's milk formula.
- Nutritional intake and plasma phosphorus levels were monitored for 16 weeks post-discharge.
- Growth parameters (weight, length, head circumference) were assessed at multiple time points.
Main Results:
- No significant differences in growth parameters were observed between the groups.
- Hypophosphatemia developed in 6 infants (50%) fed human milk.
- Lower mean vitamin D intake during hospitalization was associated with hypophosphatemia in human milk-fed infants.
Conclusions:
- Low-birth-weight infants fed human milk are at significant risk for developing hypophosphatemia after hospital discharge.
- Current hospital discharge assessments of calcium, phosphorus, and alkaline phosphatase may not adequately predict risk.
- Early vitamin D supplementation during the infant's hospital course is recommended to prevent hypophosphatemia.
Abstract:
The present study evaluated 12 infants with birth weights less than 2000 g who received human milk plus a multivitamin supplement and 20 similar infants who received standard cow's milk formula for 16 weeks from the time of initial hospital discharge. Examination at birth, at hospital discharge (study entry), at 4 and 16 weeks after hospitalization, and at 52 weeks of age revealed no intergroup differences in body weight, length, and head circumference. Hypophosphatemia (plasma phosphorus concentration less than or equal to 1.45 mmol/L) developed in 6 infants fed human milk (5 infants at 4 weeks and 1 infant at 16 weeks of study). Mean vitamin D intakes, but not calcium and phosphorus intakes, were significantly lower during hospitalization in human milk-fed infants with hypophosphatemia (44 [25, SD] IU/d) compared with those without hypophosphatemia (322 [180] IU/d). These data indicate that human milk-fed, low-birth-weight infants are at risk for hypophosphatemia following initial hospital discharge. Plasma calcium, phosphorus, and alkaline phosphatase concentrations at hospital discharge may not predict the infants at risk. Vitamin D supplementation early in the infants' hospital course may prevent hypophosphatemia.