Growth and Bone Mineralization of Very Preterm Infants at Term Corrected Age in Relation to Different Nutritional Intakes in the Early Postnatal Period

Abstract

Preterm infants often have a reduced bone mineral content (BMC) with increased risk of metabolic bone disease. After birth it is difficult to supply calcium (Ca) and phosphorus (P) comparable to the high fetal accretion rate. It is not known whether high supplementation of minerals in the early postnatal period improves growth and bone mineralization. The aim of this study was to evaluate growth and bone mineralization at term corrected age (TCA) in very and extremely preterm infants who received different enteral Ca and P intakes during the first 10 days of life. Infants (n = 109) with birth weights below 1500 g were randomly assigned to one of three groups that differed in the nutritional protocols delivered until day 10: Group A, mother’s own milk (MOM) and donor milk (unfortified); Group B, MOM (unfortified) and preterm formula; Group C, MOM (start fortification >50 mL/day) and preterm formula. Due to the earlier commencement of fortification, Group C received higher intakes of calcium and phosphorus and protein (p < 0.001) until day 10. At TCA weight, length, BMC and bone mineral density (BMD), measured by dual-X-ray absorptiometry, were not different between the groups. Nutritional intake of P was positively associated with length (β; (95% confidence interval (CI): 0.20 (0.001; 0.393); p-value = 0.048), whereas Ca intake was negatively associated with BMC (−1.94 (−2.78; −1.09); p-value < 0.001). A small interaction between Ca and P intake was only found for BMD (0.003 (0.00002; 0.00006); p-value = 0.036). The volume of human milk per kg provided during the first 10 days was positively associated with BMC (β; (95% CI): 0.013 (0.002; 0.023); p < 0.017). Higher intakes of Ca and P during the first 10 days, as provided in this study, did not improve bone mineralization at term corrected age.

Development of a human milk concentrate with human milk lyophilizate for feeding very low birth weight preterm infants: A preclinical experimental study

“…In addition, adequate early intake of protein and energy in the first week of life of VLBW infants improves the homeostasis of the electrolytes in question [52]. Preterm infants require high amounts of Ca and P elements and, due to low skeletal storages, are at increased risk of nutritional disorders such as growth and developmental deficits, hypophosphatemia, osteopenia in prematurity, and metabolic bone disease [53–54].…”

Metabolic Bone Disease of Prematurity: Risk Factors and Associated Short-Term Outcomes

“…This analytical evaluation of bone-related parameters is largely based on the presence of risk factors, but there is significant variation in screening practices across institutions [ 6 , 11 , 12 , 13 , 14 , 15 , 16 ]. Moreover, while recent significant advances in the management of VLBW infants (e.g., early aggressive parenteral nutrition, donor breast milk, human milk fortifiers) may have influenced the picture of MBD and increased survival rates, there are limited data on risk factors for MBD that could help clinicians to guide management [ 17 , 18 , 19 , 20 ]. The aim of the present study was to identify clinical factors that are associated with biochemical indicators of MBD identified in analytical screening in very preterm infants.…”

Artificial Neural Network Modeling to Predict Neonatal Metabolic Bone Disease in the Prenatal and Postnatal Periods

“…However, radiographs only reveal bone mineralization when its reduction is up to 20% to 40% and are of limited use to in the early diagnosis of MBD. Second, postnatal mineral supply, type of feeding, parenteral nutrition, and some important nutrient intake during pregnancy (eg, phosphorus, magnesium, zinc, potassium, and protein) may also be involved in bone metabolism. These indicators require further research and generative evidence before claims are made.…”