Redefining normal bone and mineral clinical biochemistry reference intervals for healthy infants in Canada

Gallo, Sina; Comeau, Kathyrn; Sharma, Atul; Vanstone, Catherine A.; Agellon, Sherry; Mitchell, John; Weiler, Hope A.; Rodd, Celia

doi:10.1016/j.clinbiochem.2014.07.012

Cited by 17 publications

(17 citation statements)

References 35 publications

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“…Overall, the percentage of infants who completed the study at 12 months was not different among the groups [9]. The ionized and total calcium and phosphorus concentrations declined significantly over time, as previously reported [8,9]. Trends in PTH and ionized calcium showed an approximate linear relationship, confirmed by loess (non-parametric) fits (not shown).…”

Section: Resultssupporting

confidence: 74%

“…Of note, iCa, total calcium and phosphorus all declined over to the first year of life, during which PTH concentrations doubled. The latter rose from almost suppressed levels to the mid-normal childhood range [8,9]. As expected, 25(OH)D concentrations (measuring the storage form of the vitamin) increased with supplementation dose, but declined after 6 months of age.…”

Section: Introductionmentioning

confidence: 66%

“…From our vitamin D dose response trial, we recently published normative data filling important gaps in the understanding of mineral status in infancy [8,9]. Of note, iCa, total calcium and phosphorus all declined over to the first year of life, during which PTH concentrations doubled.…”

Section: Introductionmentioning

confidence: 98%

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Parathyroid hormone-ionized calcium dynamics over the first year of life

Sharma

Gallo

Vanstone

et al. 2016

Journal of Pediatric Endocrinology and Metabolism

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No significant correlations were observed between iCa and PTH at individual visits (p>0.2). After accounting for repeated measures, PTH decreased with increasing iCa (slope -5.25; 95% confidence intervals (CI) -8.78 to -1.73), decreased with increasing 25(OH)D (slope -0.006; 95% CI -0.009 to -0.002, and increased with later visits (6-12 months, p<0.001), CONCLUSIONS: We observed a weak negative relationship between iCa and PTH and an increase with age consistent with physiologic maturation.

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Section: Resultssupporting

confidence: 74%

Section: Introductionmentioning

confidence: 66%

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Parathyroid hormone-ionized calcium dynamics over the first year of life

Sharma

Gallo

Vanstone

et al. 2016

Journal of Pediatric Endocrinology and Metabolism

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“…Secondary outcome was initially set as the severity of cholestasis, evaluated by the magnitude of the conjugated bilirubinemia and gamma-glutamyl transpeptidase (GGT) > 225 IU/L [21]. After the trial initiation, we also included as secondary outcome parameters total alkaline phosphatase (AP) > 608 IU/L [22]; elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), defined as >55 IU/L in female or >60 IU/L in male infants [23], were also included as markers of PN-associated liver disease.…”

Section: Methodsmentioning

confidence: 99%

Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions

Pereira‐da‐Silva

Nóbrega

Rosa

et al. 2017

Clinical Nutrition ESPEN

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s u m m a r yBackground: Cholestasis is a common complication in infants receiving prolonged parenteral nutrition (PN). We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides (MCT), 25% olive oil, and 15% fish oil (SMOF) or with 50% MCT and 50% soybean oil n-6 (MCT/SOY) on the incidence of cholestasis in surgical term and near-term neonates. Methods: A single-center, double-blinded, randomized controlled trial compared the incidence of cholestasis using either SMOF or MCT/SOY in neonates born at gestational age !34 weeks undergoing major surgery. The primary outcome was the incidence of conjugated serum bilirubin >1 mg/dL. Other liver enzymes were assessed as secondary outcomes. A post-hoc analysis assessed serum triglycerides levels. Odds ratios were estimated by mixed-effects regression models. Results: Enrollment was prematurely interrupted because the MCT/SOY became unavailable, thus 49 infants (SMOF 22, MCT/SOY 27) completed the study. The exposure (time on PN, cumulative dose of lipids) was similar in both groups. Similar cumulative incidence rates were found for elevated conjugated bilirubinemia and other liver enzymes. Hypertriglyceridemia >250 mg/dL (12/49) was more frequent in MCT/SOY (37.0%, 95% CI 21.53e55.77) than in SMOF (9.1%, 95% CI 2.53e27.81, p ¼ 0.024). Triglyceridemia at the first assessment (median 8 postnatal days) was significantly higher with MCT/SOY than with SMOF (181 vs. 134 mg/dL, p ¼ 0.006). Over the whole study period, mean triglyceride concentration was 36.5 mg/dL higher with MCT/SOY compared with SMOF (p ¼ 0.013). Conclusion: Both emulsions had similar effects on the incidence of cholestasis and markers of liver integrity, but MCT/SOY induced higher serum triglyceride concentrations. Trial registration: ClinicalTrials.gov, NCT02633384

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“…In healthy children, between 6 months and 5 years old, rates of severe ALP elevation from 2% to 6% have been reported [5][6][7] , condition not common in older children or adults 8 . The aim of this paper is to report a case series of BTH, a differential diagnosis to be considered in the event of elevated ALP, and to propose management guidelines to avoid costly tests and unnecessary distress among parents and pediatricians.…”

Section: Introductionmentioning

confidence: 99%

Hiperfosfatasemia transitoria benigna de la infancia, Serie Clinica

Rocha

2016

Revista Chilena de Pediatría

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Introduction: Alkaline Phosphatase (ALP) is a group of 4 isoenzymes produced in different tissues. Elevated levels of ALP can be developed under physiological conditions, and can indicate the presence of bone or hepatobiliary diseases. In children, one of its most common harmless causes is benign transient hyperphosphatasemia (BTH), a little known condition. The objective is to report BTH cases and propose a monitoring plan. Case reports: The cases of 5 children aged between 11 and 50 months are presented, 4 of them female, with the incidental finding of a sudden and severe ALP elevation (> 1,000 U/l), in tests ordered due to either abnormal growth and development, or intercurrent infections. Bone and liver disease were ruled out using the patient history, physical examination and basic laboratory results. Isoenzymes levels were determined in 2 patients. A return to normal ALP levels was observed over a period of 1-6 months, with no evidence of further complications. Conclusion: BTH is a benign self-limiting biochemical disorder, which should be considered in children under 5 years old with severe ALP elevation in the absence of clinical or laboratory abnormalities suggestive of bone or liver disease.

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Redefining normal bone and mineral clinical biochemistry reference intervals for healthy infants in Canada

Cited by 17 publications

References 35 publications

Parathyroid hormone-ionized calcium dynamics over the first year of life

Parathyroid hormone-ionized calcium dynamics over the first year of life

Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions

Hiperfosfatasemia transitoria benigna de la infancia, Serie Clinica

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