Nutritional hypophosphatemic rickets secondary to Neocate® use

Ali, S Akhtar; Mathalikunnel, A; Bhardwaj, Vinay Kumar; Braskett, Melinda; Pitukcheewanont, Pisit

doi:10.1007/s00198-019-04836-8

Cited by 12 publications

(7 citation statements)

References 8 publications

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“…However, AAF has been reported to lack the capability of building up tolerance and imposes high economic burden on families and healthcare systems (5,19,20). In addition, as the average duration of formula use in this case studies was longer than 6 months, prolonged use of AAF could increase the risk of hypophosphatemia and rickets as reported earlier (20)(21)(22)(23)(24). Therefore, clinicians should limit its use for extremely severe cases and when eHF is not tolerated, which is supported by this study findings (9,25,26).…”

Section: Discussionmentioning

confidence: 53%

“…The average time for clinical improvement as defined for all the clinical phenotypes was 6 days (range 1–21) after switching to the casein-based eHF. In infants with clinical manifestations of FPIAP, improvement was observed at a mean of 8 days ( 2 – 21 ), all subjects with FPIES from the 1st and the infant with severe diarrhoea after 4 days of treatment.…”

Section: Resultsmentioning

confidence: 99%

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Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

Sekkidou¹,

Muhardi²,

Constantinou

et al. 2021

Front. Allergy

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Background: The majority of mixed-fed infants with non-IgE-mediated cow's milk protein allergy (CMPA) enteropathies are managed with an extensively hydrolysed cow's milk based infant formula (eHF). Given the high variability in peptide distribution of available eHFs, it is important to understand the suitability of a specific product in the management of distinct phenotypes.Objective: To assess the symptom resolution of various phenotypes of clinical manifestations of CMPA enteropathies and constipation managed by a casein-based eHF.Methods: The data of 20 full-term infants (n = 15 with non-IgE-mediated CMPA and n = 5 with constipation) attending a paediatric allergy clinic in Cyprus and managed with a casein-based eHF were retrospectively analysed.Results: Based on the clinical symptoms and history, infants were classified into the following phenotypes: (a) 11/15 (73.3%) FPIAP, (b) 3/15 (20%) FPIES, and (c) 1/15 (6.7%) severe diarrhoea. Overall, 14 (93.3%) patients were successfully managed with the casein-based eHF and 1 (6.7%) required an AAF. This formula was effective in 91% of patients with FPIAP, in 100% with FPIES and with diarrhoea. Three (60%) patients with constipation responded to the eHF.Conclusion: This case-series report supports the efficacy of a particular casein-based eHF for the nutritional management of non-IgE mediated CMPA enteropathies.

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Section: Discussionmentioning

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

Sekkidou¹,

Muhardi²,

Constantinou

et al. 2021

Front. Allergy

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“…11 More cases of hypophosphatemia and rickets in association with the use of Neocate have been reported. 121314 When a 2-year-old girl with complicated medical history on Neocate feeds presented with recurrent fractures of long bones, child abuse was suspected initially before the diagnosis of hypophosphatemia and rickets could be made. She then responded rapidly to phosphate supplementation, both clinically and radiographically.…”

Section: Discussionmentioning

confidence: 99%

Hypophosphatemia and Metabolic Bone Disease Associated With the Use of Elemental Formula: Case Report and Review

Boddu

Venkata

2021

Journal of Neonatology

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A small percentage of infants and children develop cow’s milk protein allergy which is usually treated with exclusive breastfeeding or extensively hydrolyzed formulas. Some children might still be reactive to hydrolyzed formulas and would need elemental amino acid-based formulas. Elemental formulas are also frequently employed in treating very low birth weight babies with significant intolerance to regular preterm formulas and the resulting poor growth. All pediatric formulas are usually prepared as per international guidelines to fulfill the macro- and micronutrient requirements of growing children across a wide range of volume intakes. However, an interesting correlation is being reported recently, between the use of a specific elemental formula and the development of hypophosphatemia and significant metabolic bone disease. We discuss this phenomenon by exploring the available evidence and report 2 similar cases that we managed in our practice.

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“…Adequate dietary or additional oral phosphate supplementation will correct dietary phosphate deficiency, whereas in case of impaired dietary phosphate availability, such as in infants on amino acid-based elemental formulas (e.g., Neocate®), a change of formula will cure rickets [ 43 ]. Management of impaired phosphate absorption, e.g., due to gastrointestinal surgery or short bowel syndrome, are treated with oral or if necessary parenteral phosphate supplementation (Tables 4 and 5 ).…”

Section: Phosphopenic Ricketsmentioning

confidence: 99%

Rickets guidance: part II—management

et al. 2022

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Here, we discuss the management of different forms of rickets, including new therapeutic approaches based on recent guidelines. Management includes close monitoring of growth, the degree of leg bowing, bone pain, serum phosphate, calcium, alkaline phosphatase as a surrogate marker of osteoblast activity and thus degree of rickets, parathyroid hormone, 25-hydroxyvitamin D3, and calciuria. An adequate calcium intake and normal 25-hydroxyvitamin D3 levels should be assured in all patients. Children with calcipenic rickets require the supplementation or pharmacological treatment with native or active vitamin D depending on the underlying pathophysiology. Treatment of phosphopenic rickets depends on the underlying pathophysiology. Fibroblast-growth factor 23 (FGF23)-associated hypophosphatemic rickets was historically treated with frequent doses of oral phosphate salts in combination with active vitamin D, whereas tumor-induced osteomalacia (TIO) should primarily undergo tumor resection, if possible. Burosumab, a fully humanized FGF23-antibody, was recently approved for treatment of X-linked hypophosphatemia (XLH) and TIO and shown to be superior for treatment of XLH compared to conventional treatment. Forms of hypophosphatemic rickets independent of FGF23 due to genetic defects of renal tubular phosphate reabsorption are treated with oral phosphate only, since they are associated with excessive 1,25-dihydroxyvitamin D production. Finally, forms of hypophosphatemic rickets caused by Fanconi syndrome, such as nephropathic cystinosis and Dent disease require disease-specific treatment in addition to phosphate supplements and active vitamin D. Adjustment of medication should be done with consideration of treatment-associated side effects, including diarrhea, gastrointestinal discomfort, hypercalciuria, secondary hyperparathyroidism, and development of nephrocalcinosis or nephrolithiasis.

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Nutritional hypophosphatemic rickets secondary to Neocate® use

Cited by 12 publications

References 8 publications

Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

Hypophosphatemia and Metabolic Bone Disease Associated With the Use of Elemental Formula: Case Report and Review

Rickets guidance: part II—management

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