Effect of high-dose vitamin D supplementation on radiographically detectable bone disease of very low birth weight infants

Evans, Jacquelyn R.; Allen, Alexander C.; Stinson, Dora A.; Hamilton, David C.; Brown, Brande; Vincer, Michael; Raad, May; Gundberg, Caren M.; Cole, David E. C.

doi:10.1016/s0022-3476(89)80662-6

Cited by 28 publications

(28 citation statements)

References 24 publications

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“…Hypercalcemia and hypercalciuria were not observed and there was no sig nificant change in bone mineralization [11], However, mean serum sulfate concentra tions were significantly higher in the supple mented group at 6 weeks. We had previously noted similar changes after clinical trials of l,25(OH)2D3 therapy in patients with inher ited rickets [26], These changes were attrib uted to an apparent decrease in GFR as esti mated by creatinine clearances [24,27], but more recently, the deterioration in GFR as sociated with treatment by vitamin D ana logs has been linked to the length o f hypercalcemic episodes rather than to a direct effect o f vitamin D metabolites on the kid ney [28], In the VLBW infants, serum sulfate increased in response to vitamin D even as the serum creatinine declined.…”

Section: Discussionmentioning

confidence: 79%

“…There was no significant difference in gestational age, weight gain or intakes, despite a total vitamin D intake (the aggregate o f vitamin D in the formula or par enteral solution and the supplement) 3-to 6-fold greater in the experimental group. There were no significant differences in se rum calcium, creatinine, phosphorus, or al kaline phosphatase, nor were there any sig nificant differences in the frequency or se verity o f radiographically demonstrable bone disease [11]. During that period, the estimated GFR increased more than 80% in both groups (fig.…”

Section: Effects Of High-dose Vitamin Dmentioning

confidence: 86%

“…The de tails of design and the principal outcomes can be found elsewhere [11], but are summarized here. All infants bom at the Grace Maternity Hospital (Hali fax, N.S.)…”

Section: Methodsmentioning

confidence: 99%

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Inorganic Sulfate Metabolism in the Very Low Birthweight Infant

Cole¹,

Evans²,

Raad³

et al. 1990

Neonatology

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The effect of vitamin D supplementation on inorganic sulfate metabolism was examined in very low birth weight (< 1,500 g) infants at biweekly intervals after birth until 6 weeks of postnatal age. Baseline serum sulfate concentrations were significantly higher in all infants (471 ± 24 μmol/l, n = 80) than in adults (299 ± 25 μmol/l, n = 17). In controls, the levels did not change significantly over the ensuing 6 weeks, although serum creatinine declined. Urinary sulfate excretion rose significantly to near adult levels by 2 weeks. Both urine and serum sulfate were correlated with weight gain but not with estimated glomerular filtration rate, suggesting that factors other than renal clearance have a preponderant influence on serum sulfate in these infants. At 6 weeks, the mean serum sulfate in the high-dose group (receiving 2,170 ± 23 U/day of vitamin D, n = 41) was significantly higher than in controls (receiving 360 ± 22 U/day, n = 40). In all infants, there was a significant correlation (r = 0.36, p < 0.001) between serum sulfate and 25(OH)-vitamin D concentrations, but not other analytes or clinical variables, suggesting that vitamin D may be one of the factors modulating sulfate metabolism in the newborn period.

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Section: Discussionmentioning

confidence: 79%

Section: Effects Of High-dose Vitamin Dmentioning

confidence: 86%

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Inorganic Sulfate Metabolism in the Very Low Birthweight Infant

Cole¹,

Evans²,

Raad³

et al. 1990

Neonatology

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“…Recommendations for optimizing bone accretion in the VLBW infant include optimizing the intake of calcium and phosphorous in TPN at a ratio of 1.3-1.7:1, initiating enteral feedings as soon as medically possible, optimizing enteral intake of calcium and phosphorus by adding powdered fortifier to breast milk or using a formula made for premature infants, maintaining vitamin D intake of 400-500 IU per day, and limiting the use of diuretics and theophylline (Evans et al, 1989;Greer, 1994;Koo et al, 1989;Koo & Tsang, 1991, 1993Kruge-Wispe, 1994;Pelegano et al, 1989). In addition to dietary supplements, physical therapy (i.e., range-ofmotion exercises of the upper and lower extremities) has been shown to enhance bone mineralization and bone mineral content in VLBW infants (Moyer-Mileur, Luetkemeier, Boomer, & Chan, 1995).…”

Section: Discussionmentioning

confidence: 99%

Metabolic Bone Disease in Very-Low- Birth-Weight Infants: Assessment, Prevention, and Treatment by Neonatal Nurse Practitioners

Smith

Kirchhoff

1997

Journal of Obstetric, Gynecologic & Neonatal Nursing

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“…Thus, prolonged feed ing of low mineral milks and the low vitamin D reserves of small preterm infants theoretically could lead to low serum 250HD concentrations and a diagnosis of vitamin D deficiency. However, daily supplementation of 400 IU of vitamin D appears to be sufficient for small preterm infants receiving PN or EN while receiving the recom mended amounts of Ca and P [7,60,135,136]. Further more, increased daily vitamin D supplementation to 2000 IU/day in preterm infants does not decrease the development of radiographie osteopenia and rickets when compared to a daily vitamin D supplement of 400 IU [135].…”

Section: Journal Of the American College Of Nutritionmentioning

confidence: 94%

Mineral requirements of low-birth-weight infants.

Koo

Tsang

1991

Journal of the American College of Nutrition

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The minerals calcium (Ca), magnesium (Mg), and phosphorus (P) are essential for tissue structure and function. Recent studies have resulted in a more rational approach to the management of mineral intake in preterm infants receiving parenteral nutrition (PN) and enteral nutrition (EN). For preterm infants requiring PN, the use of PN solutions with a Ca content of 1.25-1.5 mmol/dl (50-60 mg/dl), a P content of 1.29-1.45 mmol/dl (40-45 mg/dl), and an Mg content of 0.2-0.3 mmol/dl (5-7 mg/dl) is supported by studies of mineral homeostasis with serial chemical and calciotropic hormone measurements, standard balance studies, and improved radiographic indices of bone mineralization. For infants requiring EN, an intake of approximately 4 mmol (200 mg) of Ca, 3.2 mmol (100 mg) of P, and 0.33 mmol (8 mg) of Mg/kg/day based on an average retention rate of 64% for Ca, 71% for P, and 50% for Mg should be sufficient to meet the requirements of preterm infants in early infancy. This level of intake is supported by data from balance studies using standard and stable isotope techniques, changes in bone mineral content (BMC) measurements, and calciotropic hormone data. Based on the timing of development of fractures and rickets, changes in BMC, and skeletal growth data, the increased Ca and P intake should continue for at least 3 months after birth or until reaching a body weight of about 3.5 kg. In addition, nonnutritional factors may have the potential to increase mineral loss and disturb mineral homeostasis; chronic diuretic therapy increases mineral loss, and aluminum contamination of nutrients theoretically may compound any skeletal disorder. Thus, attention to the level of mineral intake and factors important in mineral loss and mineral metabolism should optimize mineral retention in small preterm infants.

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Effect of high-dose vitamin D supplementation on radiographically detectable bone disease of very low birth weight infants

Cited by 28 publications

References 24 publications

Inorganic Sulfate Metabolism in the Very Low Birthweight Infant

Inorganic Sulfate Metabolism in the Very Low Birthweight Infant

Metabolic Bone Disease in Very-Low- Birth-Weight Infants: Assessment, Prevention, and Treatment by Neonatal Nurse Practitioners

Mineral requirements of low-birth-weight infants.

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