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Neonatal hypercalcemia in preterm infants fed with human milk
Insights
Neonatal hypercalcemia in premature infants fed human breast milk is linked to phosphorus depletion. Supplementation or modified milk corrected high calcium levels, suggesting a dietary cause.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Nutritional Science
Background:
- Hypercalcemia, defined as serum calcium (Ca) ≥ 2.83 mmol/l, is a concern in premature infants.
- Human breast milk is the primary nutrition source for many premature infants.
- Understanding metabolic disturbances in this population is crucial for optimal care.
Purpose of the Study:
- To investigate the potential link between human breast milk feeding and hypercalcemia in premature infants.
- To identify metabolic factors associated with neonatal hypercalcemia.
- To determine effective interventions for correcting hypercalcemia in this cohort.
Main Methods:
- Observational study of 10 premature infants with hypercalcemia (gestational age 31-37 weeks, birthweight 1100-1950 g).
- Analysis of serum calcium, phosphorus, parathyroid hormone, and 25-hydroxyvitamin-D levels.
- Measurement of urinary calcium and phosphorus excretion.
- Correlation analysis between serum calcium and excretion parameters.
Main Results:
- All infants were fed pooled human breast milk.
- High urinary calcium excretion and low serum/urinary phosphorus were observed.
- Serum parathyroid hormone and vitamin D levels were normal.
- Positive correlation between serum calcium and urinary calcium excretion; negative correlation with serum phosphorus and urinary phosphorus excretion.
Conclusions:
- Neonatal hypercalcemia in premature infants appears related to phosphorus depletion.
- Human breast milk may contribute to this phosphorus depletion.
- Phosphorus supplementation or modified milk feeding effectively corrected hypercalcemia.
Abstract:
Hypercalcemia (serum Ca greater than or equal to 2.83 mmol/l) was detected in 10 premature infants (gestational age: 31-37 weeks and birthweight: 1100-1950 g). All were fed with pooled human breast milk. Urinary Ca excretion was high (greater than 0.200 mmol/kg/24 h) in all but one infant while serum phosphorus (P) concentration and urinary P excretion were low. Serum immunoreactive parathyroid hormone and plasma 25-hydroxyvitamin-D concentrations were normal. A significant positive correlation was found between serum Ca concentration and urinary Ca excretion, and a negative correlation between serum Ca concentration and serum P concentration or urinary P excretion. Hypercalcemia disappeared spontaneously in two patients, was corrected by a humanized milk in three patients and by P supplementation in five patients. These data suggest that neonatal hypercalcemia is related to P depletion induced by human breast milk in premature infants.