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Effects of increased calcium and phosphorous formulas and human milk on bone mineralization in preterm infants
Insights
Preterm infants fed specialized formulas showed improved bone mineralization compared to those fed human milk. Formulas with specific calcium and phosphorus levels better approximated intrauterine bone development.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Bone Metabolism
Background:
- Preterm infants (<1,600g) require optimal nutrition for extrauterine growth.
- Bone mineralization in preterm infants is a critical concern for long-term health.
- Human milk, while beneficial, may have suboptimal mineral content for preterm bone development.
Purpose of the Study:
- To evaluate extrauterine bone mineralization in preterm infants fed different nutritional regimens.
- To compare bone mineralization rates between preterm infants fed commercial formulas versus mother's milk.
- To determine which formula composition best supports bone mineralization approximating intrauterine rates.
Main Methods:
- Photon absorptiometry used to assess bone mineralization in preterm infants.
- Four feeding groups: standard premature formula, high-phosphorus formula, high-calcium/high-phosphorus formula, and mother's milk.
- Biochemical markers (serum calcium, phosphorus, etc.) monitored bi-weekly.
Main Results:
- Infants fed human milk exhibited a lower bone mineralization rate compared to all formula groups.
- Bone mineral content was comparable across the three formula-fed groups.
- Formulas with 117 mg Ca/58.5 mg P or 140 mg Ca/82 mg P per 100 kcal approximated intrauterine bone mineralization.
- Human milk feeding did not approximate intrauterine bone mineralization rates.
Conclusions:
- Specific calcium and phosphorus concentrations in preterm formulas are crucial for achieving intrauterine-like bone mineralization.
- Standard preterm formulas with adjusted mineral content can support adequate bone development in preterm infants.
- Exclusive human milk feeding may lead to suboptimal bone mineralization in preterm infants compared to fortified formulas.
Abstract:
By photon absorptiometry, extrauterine bone mineralization was evaluated in preterm infants (less than 1,600 g birth weight) fed either a commercial premature formula containing 117 mg calcium, 58.5 mg phosphorus/100 kcal, the same formula containing higher phosphorus (82 mg/100 kcal), the same formula with higher calcium (140 mg Ca) and phosphorus (82 mg/100 kcal), or their own mother's milk. All infants had serum protein, albumin, calcium, phosphorus, bicarbonate, 25-hydroxyvitamin D, and alkaline phosphatase levels done at the start of the study and every 2 weeks until they weighed 1,900 g. At the start of the study, birth weight and gestational ages were similar in all four groups. There were no biochemical differences among the four groups except for a lower serum P in the human milk group. The human milk group had lower bone mineralization rate compared with the three formula groups. Bone mineral content was similar in the three formula-fed groups. However, only formulas containing 117 mg Ca and 58.5 mg P or 140 mg Ca and 82 P mg/100 kcal approximated intrauterine bone mineralization. Human milk fed infants did not approximate and were significantly different from the intrauterine rate.