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Prevalence of Metabolic Bone Disease in Tube-Fed Children Receiving Elemental Formula
Ana L Creo1, Lisa M Epp2, Julie A Buchholtz3
1Division of Pediatric Endocrinology, Mayo Clinic, Rochester, Minnesota, USA, creo.ana@mayo.edu.
Insights
A study found that up to 23% of tube-fed children using Neocate experienced hypophosphatemia and bone disease. This highlights the need for careful monitoring of metabolic bone disease in children on elemental formulas.
Area of Science:
- Pediatric Nutrition
- Metabolic Bone Disease
Background:
- Previous studies indicated normal mineral status in children on elemental formulas.
- A recent survey identified 51 children with hypophosphatemia and bone disease on elemental formula.
- This study investigates metabolic bone disease in children using extensively hydrolyzed or amino acid-based formulas.
Purpose of the Study:
- To determine the prevalence of metabolic bone disease in tube-fed children receiving extensively hydrolyzed or amino acid-based formula.
- To assess the risk of hypophosphatemia and bone abnormalities in infants using specific elemental formulas.
Main Methods:
- Retrospective cohort study of tube-fed children using an institutional database.
- Defined confirmed cases by biochemical and radiographic evidence of bone disease (rickets/fractures).
- Defined suspected cases by partial biochemical or radiographic evidence of bone disease.
Main Results:
- 102 tube-fed children on elemental/semi-elemental formulas (Neocate, EleCare, Pregestimil, Alimentum) were identified.
- Among children on Neocate with monitoring data (46%), 23% developed hypophosphatemia and bone abnormalities.
- These bone issues resolved with phosphorus supplementation or formula change.
Conclusions:
- An estimated 11% to 23% of tube-fed children on Neocate develop metabolic bone disease.
- Cautious use of Neocate is recommended for this population.
- Monitoring for evolving bone disease in children on Neocate is advised.
Background:
Previous studies suggest normal mineral status in children receiving elemental formula. However, a recent multicenter survey described 51 children who developed hypophosphatemia and bone disease while receiving elemental formula. Our aim is to determine the prevalence of metabolic bone disease in children receiving extensively hydrolyzed or amino acid-based formula.
Methods:
We established a retrospective cohort using an institutional database of tube-fed children. We defined a "confirmed case" as a child with biochemical and radiographic evidence of bone disease (rickets and/or low-trauma fractures). We defined a "suspected case" as a child who had biochemical evidence and/or radiographic evidence of bone disease but with incomplete data during the review period.
Results:
A total of 102 tube-fed children receiving elemental or semi-elemental formula were identified. The four elemental and semi-elemental formulas evaluated were Neocate®, EleCare®, Pregestimil®, and Alimentum®. Not all children had complete monitoring data performed during the review period. Of the children receiving Neocate who had monitoring data (46%), 23% developed hypophosphatemia and radiographic abnormalities (fractures or rickets), which resolved with phosphorus supplementation and/or change in the formula brand.
Conclusions:
We estimate that at least 11% and up to 23% of all tube-fed children receiving Neocate develop metabolic bone disease. Based upon the estimated prevalence, we recommend cautious use of this formula with monitoring for evolving bone disease in this population.
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