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Incidence of Metabolic Bone Disease After Implementation of Bone Protective Nutritional Strategies: A Prospective
Arif Abdulsalam Kolisambeevi1, Femitha Pournami2, Ajai Kumar Prithvi1
1Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala.
Insights
A new bone health nutritional strategy (BNS) reduced metabolic bone disease (MBD) incidence in preterm infants. This approach, using early phosphorus and human milk fortifier, proved safe and feasible for vulnerable newborns.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Bone Metabolism
Background:
- Metabolic bone disease (MBD) is a common complication in very preterm infants, often resulting from multifactorial causes.
- High incidence of MBD necessitates targeted interventions to improve bone health in this vulnerable population.
Purpose of the Study:
- To evaluate the incidence of MBD in preterm infants (<30 weeks gestation) following the implementation of a bone health-focused nutritional strategy (BNS).
- To assess the safety and feasibility of the BNS, including early phosphorus supplementation and human milk fortification.
Main Methods:
- A prospective cohort study involving preterm newborns (<30 weeks gestation).
- The BNS included early intravenous potassium phosphate, early multicomponent human milk fortifier (HMF) at 40 mL/kg/day enteral feeds, and weekly phosphorus monitoring.
- Incidence of MBD at 4 weeks postnatal age and beyond was analyzed, along with safety outcomes.
Main Results:
- The incidence of MBD in neonates receiving the BNS was 20.9%.
- Low rates of hyperphosphatemia (4.5%) and hyperkalemia (2.9%) were observed.
- Full enteral feeds were achieved by a median of 6 postnatal days.
Conclusions:
- The implemented bone health nutritional strategy (BNS) resulted in a 20.9% incidence of MBD in preterm infants (24-30 weeks gestation).
- Early administration of intravenous potassium phosphate and human milk fortifier (HMF) was found to be safe and feasible.
Background:
Metabolic bone disease (MBD) is a morbidity of multifactorial etiology with a high incidence in very preterm infants. We planned to study the incidence of MBD after implementation of bone health focussed nutritional strategy (BNS) in those <30 weeks gestation at birth.
Methods:
This prospective cohort study including preterm newborns (<30 weeks) who received nutrition that incorporated (a) Early initiation of intravenous potassium phosphate; (b) Early enteral supplementation with multicomponent human milk fortifier at enteral feed tolerance of 40 mL/kg/day feeds itself; and (c) Weekly phosphorus measurements with optimization of enteral intakes. Incidence of MBD at 4 weeks of postnatal age and beyond were analyzed. Other relevant safety and clinical outcomes were measured.
Results:
Of the 67 included neonates receiving BNS, 20.9% were classified as MBD. There was a low rate of hyper-phosphatemia (4.5%) and hyperkalemia (2.9%). Full enteral feeds were achieved by median (IQR) of 6 (5,7) postnatal days.
Conclusion:
In preterm newborns (24-30 weeks) MBD incidence was 20.9% after BNS was implemented. Intravenous potassium salt of phosphorus and early use of HMF were safe and feasible.
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