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Continuous nasogastric phosphorus infusion in hypophosphatemic rickets of prematurity
Insights
This study found that phosphorus deficiency, not vitamin D, caused rickets in a preterm infant. Continuous phosphorus infusion successfully treated the condition without causing hypocalcemia.
Area of Science:
- Pediatric Endocrinology
- Nutritional Science
- Neonatology
Background:
- Nutritional rickets can occur in preterm infants despite vitamin D supplementation.
- Hypophosphatemia is a potential cause of rickets, but vitamin D deficiency is more common.
- Assessing the etiology of rickets in complex neonatal cases is crucial.
Observation:
- A preterm infant presented with radiologic and biochemical signs of rickets.
- The infant received high doses of ergocalciferol (vitamin D2) and had elevated serum 25-hydroxyvitamin D levels.
- Rickets persisted despite adequate vitamin D status, suggesting an alternative cause.
Findings:
- Rickets resolved solely with phosphorus supplementation using continuous nasogastric infusion.
- This method rapidly achieved and maintained normophosphatemia without inducing hypocalcemia.
- The findings strongly indicate phosphorus deficiency as the primary cause of rickets in this case.
Implications:
- Continuous phosphorus infusion may be a superior method for treating hypophosphatemic rickets compared to bolus administration.
- This technique could prevent intermittent hyperphosphatemia associated with standard phosphorus supplements.
- Further research into continuous phosphorus infusion for infantile hypophosphatemic states is warranted.
Abstract:
Radiologic and biochemical abnormalities associated with nutritional hypophosphatemic rickets were discovered in a 945-g preterm infant despite daily supplementation with 800 to 1,600 IU of ergocalciferol (vitamin D2) and an elevated serum 25-hydroxyvitamin D concentration. Vitamin D supplementation was stopped, and the rickets was corrected by phosphorus supplement alone with the use of a unique technique of long-term, continuous nasogastric phosphorus infusion. Normophosphatemia was rapidly achieved and effectively maintained. Hypocalcemia did not occur at rates of infusion of 100 mg of elemental phosphorus per day. The data are consistent with specific phosphorus deficiency as the cause of rickets in this infant, rather than insufficient vitamin D intake or disturbed vitamin D metabolism. We speculated that continuous phosphorus infusion prevents the intermittent hyperphosphatemia of bolus phosphorus supplement and that continuous phosphorus infusion may be useful in the treatment of other hypophosphatemic states of infancy.