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Update on Calcium and Phosphorus Requirements of Preterm Infants and Recommendations for Enteral Mineral Intake

Walter Mihatsch1,2, Ulrich Thome3, Miguel Saenz de Pipaon4

  • 1Department of Pediatrics, Ulm University, 89075 Ulm, Germany.

Nutrients
|April 30, 2021
PubMed

Insights

Current calcium and phosphorus recommendations for preterm infants are insufficient for optimal bone growth. Increased mineral intake, particularly calcium, is crucial for improving bone mineralization and long-term bone health in these vulnerable infants.

Area of Science:

  • Neonatology
  • Pediatric Nutrition
  • Bone Metabolism

Background:

  • Preterm infants, especially very low birth weight (VLBW) infants, often fail to achieve adequate bone mineral content (BMC) compared to term infants.
  • VLBW infants show delayed bone mass accrual, with deficits persisting into early childhood and potentially leading to long-term bone health issues like osteopenia and osteoporosis.
  • Adults born preterm with VLBW or small for gestational age (SGA) exhibit lower peak bone mass and increased fracture risk, highlighting the critical need for improved bone accretion during infancy.

Purpose of the Study:

  • To review current enteral mineral recommendations for preterm infants.
  • To provide evidence-based recommendations for optimizing enteral mineral intake to enhance bone mineral accretion in preterm infants.
  • To address the long-term implications of suboptimal bone mineralization in preterm populations.

Main Methods:

  • A narrative review of current calcium (Ca) and phosphorus (P) recommendations for preterm infants.
  • Analysis of fetal and preterm infant physiology related to mineral accretion.
  • Synthesis of data to formulate recommendations for improving bone mineral accretion.

Main Results:

  • Existing Ca and P recommendations for preterm infants systematically underestimate their actual mineral requirements, with a particular deficit in calcium.
  • Current enteral nutrition strategies are insufficient to support adequate bone mineralization in preterm infants.

Conclusions:

  • Higher mineral content in enteral fortifiers or formulas is necessary to meet the needs of preterm infants.
  • Increased general mineral intake, especially calcium, is likely to improve bone mineralization and potentially long-term bone health.
  • Individualized enteral calcium and/or phosphorus supplementation is recommended to optimize bone accretion while monitoring for potential risks like nephrocalcinosis.
Abstract

Keywords:
bone mineral contentbone mineralizationcalcium requirementsphosphorus requirementspreterm infant

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