Hypophosphatemia and hypercalciuria in small premature infants fed human milk: evidence for inadequate dietary phosphorus
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Premature infants fed only human milk had lower phosphorus and calcium intake and retention. This feeding strategy may lead to deficiencies in these essential minerals, impacting infant health.
Area of Science:
- Neonatal nutrition
- Pediatric mineral metabolism
Background:
- Premature infants require careful monitoring of nutrient balance.
- Human milk composition may differ significantly from infant formulas regarding mineral content.
Purpose of the Study:
- To prospectively assess phosphorus (P) and calcium (Ca) balance in stable premature infants fed either human milk or standard formula.
- To identify potential mineral deficiencies associated with exclusive human milk feeding in this population.
Main Methods:
- Prospective study measuring P and Ca balance in premature infants (<1600 gm).
- Comparison between infants fed human milk versus standard commercial formula.
- Analysis of mineral intake, serum concentrations, renal reabsorption, and excretion.
Main Results:
- Infants fed human milk had 2-3 times lower P and Ca intake compared to formula-fed infants.
- Human milk-fed infants exhibited low serum P, normal serum Ca, complete renal P reabsorption, and elevated renal Ca excretion.
- Net retention of P and Ca was reduced by 50% in the human milk group.
- Elevated alkaline phosphatase was the primary indicator of rickets.
Conclusions:
- Exclusive human milk feeding in stable premature infants is associated with phosphorus deficiency.
- Calcium sufficiency is marginal, with significant urinary losses observed.
- Biochemical changes suggest inadequate P and Ca supply from human milk alone for optimal growth and development in premature infants.
Abstract:
Phosphorus and calcium balance was measured prospectively in stable premature infants (less than or equal to 1600 gm) fed human milk or a standard commercial formula. Throughout the study, the P and Ca intakes of the infants fed human milk were two to three times less than those of infants fed formula. Infants fed human milk showed low serum P and normal serum Ca concentrations, complete renal reabsorption of P, and elevated renal Ca excretion. The net effect in infants fed human milk was a 50% reduction in the P and Ca retention, compared with the formula-fed group. Despite the unfavorable P and Ca balance in the group fed human milk, the only evidence of rickets was elevated alkaline phosphatase activity. Nevertheless, based on the biochemical changes in these infants, low serum P values, and excess urinary calcium losses, we conclude that the stable small premature infant fed human milk exclusively is deficient in phosphorus and only slightly more sufficient in calcium.