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Rickets in very-low-birth-weight infants born at Baragwanath Hospital
1MRC Mineral Metabolism Research Unit, Baragwanath Hospital, Johannesburg.
Insights
Mineral and bone metabolism disturbances are common in very-low-birth-weight infants fed breast milk. Supplementing with preterm formula did not improve weight gain or bone health outcomes.
Area of Science:
- Neonatal nutrition
- Pediatric mineral metabolism
- Infant bone health
Background:
- Very-low-birth-weight (VLBW) infants fed breast milk often experience disturbed mineral and bone metabolism.
- Rickets and osteopenia are concerns in this vulnerable population.
Purpose of the Study:
- To assess mineral homeostasis disturbances in VLBW infants fed breast milk.
- To determine if adding preterm infant formula reduces these disturbances and improves weight gain.
Main Methods:
- Fifty-three VLBW neonates were randomized at 2 weeks to receive breast milk only or breast milk with preterm formula.
- Infants were monitored for weight gain, growth, and biochemical/radiological signs of metabolic bone disease.
- All infants received vitamin D supplementation.
Main Results:
- Weight gain and growth were similar between groups.
- Higher calcium and phosphorus intake in the mixed feeding group did not alter serum mineral levels.
- Radiological rickets was rare, but osteopenia and periosteal reactions were frequent and similar in both groups.
Conclusions:
- Overt rickets is uncommon in VLBW infants at Baragwanath Hospital.
- Biochemical abnormalities related to mineral metabolism are frequent despite supplementation.
- Preterm formula supplementation did not significantly improve bone health outcomes or growth in this cohort.
Abstract:
Disturbed mineral and bone metabolism has been reported to occur frequently in very-low-birth-weight infants fed breast-milk during the first 3 months of life. This study was designed to assess the prevalence of disturbed mineral homeostasis in a breast-milk-fed very-low-birth-weight population at Baragwanath Hospital and to determine whether the addition of a preterm infant formula to the feeds would reduce this prevalence and increase the rate of weight gain. Fifty-three neonates weighing less than 1 200 g at birth were monitored for weight gain, growth and biochemical and radiological evidence of metabolic bone disease at 2-weekly intervals during hospitalisation and for 18 weeks after discharge. The infants were randomised at 2 weeks of age to receive either breast-milk only, or a combination of breast-milk and a premature formula containing 550 mg calcium and 300 mg phosphorus. All infants received 800 IU vitamin D daily from day 14. Weight gain and growth were similar in both groups. Calcium and phosphorus intakes were higher in the mixed feeding group, but did not affect serum mineral levels. Radiological rickets was uncommon in both groups although periosteal reactions and osteopenia occurred frequently and with similar prevalences. Vitamin D deficiency was not found to be a problem. In conclusion, overt rickets is not a major problem in very-low-birth-weight infants born at Baragwanath Hospital, although biochemical abnormalities occur frequently.(ABSTRACT TRUNCATED AT 250 WORDS)