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Calcium and phosphorus requirements in bone mineralization of preterm infants
G M Chan1, L Mileur, J W Hansen
1Department of Pediatrics, University of Utah, Salt Lake City.
Insights
Preterm infant formulas with specific calcium and phosphorus levels better support bone mineralization than human milk. Higher calcium and phosphorus in formula closely mimic intrauterine bone growth rates.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Bone Metabolism
Background:
- Postnatal bone mineralization is crucial for preterm infants.
- Human milk may not provide adequate minerals for optimal bone development in premature neonates.
- Commercial formulas are often used to meet nutritional needs of preterm infants.
Purpose of the Study:
- To compare postnatal bone mineralization in preterm infants fed different formulas versus mother's milk.
- To evaluate the impact of varying calcium and phosphorus concentrations in premature formula on bone mineral content.
- To assess serum biochemical markers related to bone metabolism.
Main Methods:
- Photon absorptiometry was used to measure bone mineralization in 36 preterm infants.
- Infants were fed one of four diets: standard premature formula, higher phosphorus formula, higher calcium and phosphorus formula, or mother's milk.
- Serum levels of calcium, phosphorus, vitamin D, and alkaline phosphatase were monitored bi-weekly.
Main Results:
- Infants fed human milk exhibited lower serum phosphate and bone mineral values compared to formula groups.
- Bone mineral content was comparable across the three formula groups.
- Formulas with higher calcium and phosphorus concentrations (117 mg Ca/100 kcal, 58.8 mg P/100 kcal and 140 mg Ca/100 kcal, 82 mg P/100 kcal) best approximated the intrauterine bone mineralization curve.
- Bone mineral content in the human milk group was below the intrauterine rate.
Conclusions:
- Specific premature formulas can support bone mineralization more effectively than human milk for preterm infants.
- Optimized calcium and phosphorus content in formula is essential for achieving intrauterine bone mineralization rates.
- Further research into tailored nutritional strategies for preterm infants is warranted.
Abstract:
We studied postnatal bone mineralization, as measured by photon absorptiometry, in 36 preterm infants (birth weight less than 1600 gm) who were fed (1) a commercial premature formula containing 117 mg calcium and 58.8 mg phosphorus per 100 kcal, (2) the same formula containing a higher concentration of phosphorus (82 mg/100 kcal), (3) the same formula with higher concentrations of calcium (140 mg/100 kcal) and phosphorus (82 mg/100 kcal), or (4) their mother's milk. Serum calcium, phosphorus, protein, albumin, bicarbonate, 25-hydroxyvitamin D, and alkaline phosphatase levels were measured at the start of the study and every 2 weeks until the infants achieved a weight of 1900 gm. Birth weights and gestational ages were similar in all four groups. The human milk group had lower serum phosphate and bone mineral values than those in the three formula groups. Bone mineral content was similar in the three formula groups. However, only the formulas of the first and third groups allowed approximation of the intrauterine bone mineralization curve. Bone mineral content in infants fed human milk was below the intrauterine rate.