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Etiologic factors in rickets of very low-birth-weight infants
Insights
Rickets affects 32% of very low birth weight (VLBW) infants, often linked to nutritional deficiencies. Early supplementation of calcium, phosphorus, and vitamin D is crucial for VLBW infants to prevent this condition.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Bone Metabolism
Background:
- Rickets is a significant concern in premature infants.
- Very low birth weight (VLBW) infants are particularly vulnerable to bone health issues.
- Previous studies highlight the need for optimized nutritional strategies in VLBW infants.
Purpose of the Study:
- To determine the incidence of rickets in survivors of very low birth weight (VLBW).
- To investigate potential etiological factors contributing to rickets in this population.
- To evaluate the adequacy of current nutritional practices for VLBW infants.
Main Methods:
- Retrospective review of 125 VLBW infant survivors.
- Analysis of serial radiographic and biochemical data.
- Comparison of nutritional intakes (calcium, phosphorus, vitamin D, calories) and clinical factors.
Main Results:
- Rickets incidence was 32% (39/125) in the studied VLBW infant cohort.
- Risk factors included being Black, greater initial weight loss, and longer hospitalization.
- Soy formula, even with calcium and vitamin D supplementation, did not prevent rickets, indicating phosphorus deficiency.
- Nutritional intakes were similar across groups, suggesting formula composition is key.
Conclusions:
- Nutritional deficiency, particularly insufficient calcium and phosphorus, is central to rickets etiology in VLBW infants.
- Standard soy formulas and human milk do not meet the high accretion rates required for VLBW infants.
- Proactive supplementation of calcium, phosphorus, and vitamin D from birth is recommended for VLBW infants.
Abstract:
The incidence of rickets was found to be 32% (39/125) in a retrospective review of consecutive survivors of very low birth weight in whom serial radiographic and biochemical data were obtained. A higher proportion of these infants were black, had a greater initial weight loss, and had a longer hospitalization; there was a prevalence of births in the spring. Soy formula, supplemented with calcium and vitamin D but not phosphorus, was used predominantly in both groups; cumulative calcium, phosphorus, vitamin D, and caloric intakes were the same. We believe that the etiology of rickets in VLBW infants is multifactorial; however, nutritional deficiency is of central importance. Soy isolate formula, as well as human milk and many other commercially available formulas, do not provide sufficient calcium and phosphorus to keep pace with rates of intrauterine accretion. Supplementation with calcium, phosphorus, and vitamin D, beginning as soon as possible after birth, is indicated.