Calcium and Phosphorus Balance in Preterm Infants Fed Human Milk or Human Milk Supplemented with Vitamin D and Minerals

  • Jacques Senterre

Abstract

The recommended intakes for calcium (Ca), phosphorus (P), and vitamin D in the preterm infant remain an area of ongoing controversy.1–3 Because of the rapid rate of growth, hypomineralization of bone or overt rickets have been frequently observed in preterm infants fed human milk or standard formulas. The pathogenesis of the skeletal lesions is often multifactorial. Inadequate Ca and P intakes, copper and zinc deficiencies, and poor vitamin D status have all been implicated.1–3

Keywords

Preterm Infant Bone Mineral Content Human Milk Hypophosphatemic Rickets Mineral Homeostasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Atkinson SA. Calcium and phosphorus requirements of low birth weight infants: a nutritional and endocrinological perspective. Nutr Rev 41:69–78 (1983).CrossRefGoogle Scholar
  2. 2.
    Hillman LS. Mineralization and late mineral homeostasis in infants. Role of mineral and vitamin D sufficiency and other factors, in: “Perinatal Calcium and Phosphorus Metabolism,” Holick MF, Gray TK, Anast CS, eds, Elsevier, Amsterdam (1983).Google Scholar
  3. 3.
    Greer FR, Tsang RC. Calcium phosphorus, magnesium, and vitamin D requirements for the preterm infant, in: “Vitamin and Mineral Requirement for the Preterm Infants,” Tsang RC, ed., Marcel Dekker, New York (1985).Google Scholar
  4. 4.
    Widdowson EM. Changes in body composition during growth, in: “Scientific Foundations of Paediatrics,” Davis JA, Dobbing J, eds, William Heinemann Medical Books Ltd, London (1981).Google Scholar
  5. 5.
    Ziegler EE, Biga RL, Fomon SJ. Nutritional requirement of the premature infant, in: “Textbook of Pediatric Nutrition,” Suskind RM, ed., Raven Press, New York (1981).Google Scholar
  6. 6.
    Atkinson SA, Radde LC, Chance GW. Macro-mineral content of milk obtained during early lactation from mothers of premature infants. Early Hum Dev 4:5–14 (1980).CrossRefGoogle Scholar
  7. 7.
    Senterre J. Endogenous faecal calcium, total digestive juice calcium net and true calcium absorption in premature infants, in: “Perinatal Medicine,” Stembera ZK, Polacek K, Sabata V, eds, Georg Thieme, Stuttgart (1976).Google Scholar
  8. 8.
    Senterre J. Calcium and phosphorus retention in preterm infants, in: “Intensive care in the newborn, II,” Stern L, Oh W, Friis-Hansen B, eds, Masson, New York (1978).Google Scholar
  9. 9.
    Senterre J, David L, Salle B. Effects of 1, 25-dihydroxycholecalciferol on calcium, phosphorus and magnesium balance, and on circulating parathyroid hormone and calcitonin in pretera infants, in: “Intensive care in the newborn III,” Stern L, Salle B, eds, Masson, New York (1980).Google Scholar
  10. 10.
    Senterre J, Salle B. Calcium and phosphorus economy of the pretera infant and its interaction with vitamin D and its metabolites. Acta Paediatr Scand 296:85–92 (1982).CrossRefGoogle Scholar
  11. 11.
    Senterre J, Putet G, Salle B, Rigo J. Effects of vitamin D and phosphorus supplementation on calcium retention in preterm infants fed banked human milk. J Pediatr 103:305–7 (1983).CrossRefGoogle Scholar
  12. 12.
    Salle B, Senterre J, Putet G, Rigo J. Effects of calcium and phosphorus supplementation on calcium retention and fat absorption in preterm infants fed pooled human milk. J Pediatr Gastroenterol Nutr 5:638–42 (1986).CrossRefGoogle Scholar
  13. 13.
    Senterre J, Sodoyez-Goffaux F, Lambrechts A. Metabolic balance studies in premature babies. I. Methodology. Acta Paediatr Belg 25:133–42 (1971).Google Scholar
  14. 14.
    Reeve LE, Chesney RW, Deluca HF. Vitamin D of human milk: identification of biologically active forms. Am J Clin Nutr 36:122–6 (1982).Google Scholar
  15. 15.
    Greer FR, Reeve LE, Chesney RW, Deluca HF. Water-soluble vitamin D in human milk: a myth. Pediatrics 69:238 (1982).Google Scholar
  16. 16.
    Delvin EE, Glorieux FH, Salle BL, David L, Varenne JP. Control of vitamin D metabolism in preterm infants: fetomaternal relationships. Arch Dis Child 57:754–7 (1982).CrossRefGoogle Scholar
  17. 17.
    Bouillon R, Van Baelen H, De Moor P. 25-hydroxyvitamin D and its binding protein in maternal and cord serum. J Clin Endocrinol Metabol 45:679–84 (1977).CrossRefGoogle Scholar
  18. 18.
    Hillman LS, Hoff N, Salmons S, Martin L, McAlister W, Haddad J. Mineral homeostasis in very premature infants: serial evaluation of serum 25-hydroxyvitamin D, serum minerals, and bone mineralization. J Pediatr 106:970–80 (1985).CrossRefGoogle Scholar
  19. 19.
    Hillman LS, Hollis B, Salmons S, Martin L, Slatopolsky E, McAlister W, Haddad J. Absoption, dosage, and effect on mineral homeostasis of 25-hydroxycholecalciferol in premature infants: comparison with 400 and 800 IU vitamin D2 supplementation. J Pediatr 106:981–9 (1985).CrossRefGoogle Scholar
  20. 20.
    Pettifor JM, Stein H, Herman A, Ross FP, Blumenfeld T, Moodley GP. Mineral homeostasis in very low birth weight infants fed either own mother’s milk or pooled pasteurized preterm milk. J Pediatr Gastroenterol Nutr 5:248–53 (1986).Google Scholar
  21. 21.
    Markestad T, Aksnes L, Finne PH, Aarkog D. Vitamin D nutritional status of premature infants supplemented with 500 IU vitamin D2 per day. Acta Paediatr Scand 72:517–20 (1983).CrossRefGoogle Scholar
  22. 22.
    Salle BL, David L, Glorieux FH, Delvin E, Senterre J, Renaud H. Early oral administration of vitamin D and its metabolites in premature neoanates: effect on mineral homeostasis. Pediatr Res 16:75–8 (1982).CrossRefGoogle Scholar
  23. 23.
    Glorieux FH, Salle BL, Delvin EE, David L. Vitamin D metabolism in preterm infants: serum calcitriol levels during the first five days of life. J Pediatr 99:640–3 (1981).CrossRefGoogle Scholar
  24. 24.
    Seino Y, Ishii T, Shimotsuji T, Ishida M, Yabuuchi N. Plasma active vitamin D concentration in low birthweight infants with rickets and its response to vitamin D treatment. Arch Dis Child 56:628–32 (1981).CrossRefGoogle Scholar
  25. 25.
    Rowe JC, Wood DH, Rowe DW, Raisz LG. Nutritional hypophosphatemic rickets in a premature infant fed breast milk. N Engl J Med 300:293–6 (1979).CrossRefGoogle Scholar
  26. 26.
    Steichen JJ, Tsang RC, Greer FR, Ho M, Hug G. Elevated serum 1, 25-dihydroxyvitamin D concentrations in rickets of very low-birthweight infants. J Pediatr 99:293–8 (1981).CrossRefGoogle Scholar
  27. 27.
    Von Sydow G. A study of the development of rickets in premature infants. Acta Paediatr Scand suppl. 11: 1-22 (1946).Google Scholar
  28. 28.
    Callenbach JC, Sheehan MB, Abramson SJ, Hall RT. Etiologic factors in rickets of very low-birth-weight infants. J Pediatr 98:800–5 (1981).CrossRefGoogle Scholar
  29. 29.
    Atkinson SA, Radde IC, Anderson GH. Macromineral balances in premature infants fed their own mothers’ milk or formula. J Pediatr 102:99–106 (1983).CrossRefGoogle Scholar
  30. 30.
    Gross SJ. Growth and biochemical response of preterm infants fed human milk or modified infant formula. N Engl J Med 308:237–41 (1983).CrossRefGoogle Scholar
  31. 31.
    Hillman LS, Salmons SJ, Slatopolsky E, McAlister WH. Serial serum 25-hydroxyvitamin D and mineral homeostasis in very premature infants fed preterm human milk. J Pediatr Gastroenterol Nutr 4:762–70 (1985).CrossRefGoogle Scholar
  32. 32.
    Lyon AJ, McIntosh N. Calcium and phosphorus balance in extremely low birthweight infants in the first six weeks of life. Arch Dis Child 59:1145–50 (1984).CrossRefGoogle Scholar
  33. 33.
    Lyon AJ, Mclntosh N, Wheeler K, Brooke OG. Hypercalcaemia in extremely low birthweight infants. Arch Dis Child 59:1141–4 (1984).CrossRefGoogle Scholar
  34. 34.
    Rowe J, Rowe P, Horak E, Spackman T, Saltzman R, Robinson S, Philipps A, Raye J. Hypophosphatemia and hypercalciuria in small premature infants fed human milk: Evidence for inadequate dietary phosphorus. J Pediatr 104:112–7 (1984).CrossRefGoogle Scholar
  35. 35.
    Sagy M, Birenbaum E, Balin A, Orda S, Barzilay Z, Brish M. Phosphate-depletion syndrome in a premature infant fed human milk. J Pediatr 96:683–5 (1986).Google Scholar
  36. 36.
    Schanler RJ, Garza C, O’Brian Smith E. Fortified mothers’ milk for low birth weight infants: Results of macromineral balance studies. J Pediatr 107:767–74 (1985).CrossRefGoogle Scholar
  37. 37.
    Sann L, Loras B, Pavid L, Purr F, Simonnet C, Baltassat P, Bethenod M. Effect of phosphate supplementation to breast fed very low birthweight infants on urinary calcium excretion, serum immunoreactive parathyroid hormon and plasma 1. 25-dihydro-vitamin P concentration. Acta Paediatr Scand 74:664–8 (1985).CrossRefGoogle Scholar
  38. 38.
    Chan GM, Mileur L, Hansen JW. Effects of increased calcium and phosphorus formulas and human milk on bone mineralization in preterm infants. J Pediatr Gastroenterol Nutr 5:444–9 (1986).CrossRefGoogle Scholar
  39. 39.
    Modanlou HP, Lim MO, Hansen JW, Sickles V. Growth, biochemical status, and mineral metabolism in very-low-birth-weight infants receiving fortified preterm human milk. J Pediatr Gastroenterol Nutr 5:762–7 (1986).CrossRefGoogle Scholar
  40. 40.
    Carey PE, Goetz CA, Horak E, Rowe JC. Phosphorus wasting during phosphorus supplementation of human milk feedings in preterm infants. J Pediatr 107:790–4 (1985).CrossRefGoogle Scholar
  41. 41.
    Kovar IZ, Mayne PP, Robbe I. Hypophosphotemic rickets in the preterm infant, hypocalcaemia after calcium and phosphorus supplementation. Arch Dis Child 58:629–31 (1983).CrossRefGoogle Scholar
  42. 42.
    Koo WWK, Gupta JM, Nayanar VV, Wilkinson M, Posen S. Continuous nasogastric phosphorus infusion in hypophosphotemic rickets of prematurity. Am J Dis Child 138:172–5 (1984).Google Scholar
  43. 43.
    Goldsmith MA. Renal calcification in premature infants. Pediatrics 71:992 (1983).Google Scholar
  44. 44.
    Harrison JE, Hitchman JW, Hitchman A, Hasany SA, McNeill KG, Tarn CS. Pifferences between the effects of phosphate deficiency and vitamin P deficiency in bone metabolism. Metabolism 29:1225–9 (1980).CrossRefGoogle Scholar
  45. 45.
    Greer FR, Steichen JJ, Tsang RC. Calcium and phosphate supplements in breast milk-related rickets. Results in a very-low-birth-weight infant. Am J Dis Child 136:581–3 (1982).Google Scholar
  46. 46.
    Greer FR, Steichen JJ, Tsang RC. Effects of increased calcium, phosphorus, and vitamin P intake on bone mineralization in very-low-birthweight infants fed formulas with polycose and medium-chain triglycerides. J Pediatr 100:951–5 (1982).CrossRefGoogle Scholar
  47. 47.
    Helin I, Landin LA, Nilsson BE. Bone mineral content in preterm infants at age 4 to 16. Acta Paediatr Scand 74:264–7 (1985).CrossRefGoogle Scholar
  48. 48.
    Katz L, Hamilton JR. Fat absorption in infants of birth weight less than 1,300 gm. J Pediatr 85:608–14 (1974).CrossRefGoogle Scholar
  49. 49.
    Chappell JE, Clandinin MT, Kearney-Volpe C, Reichman B, Swyer PW. Fatty acid balance studies in premature infants fed human milk or formula: effect of calcium supplementation. J Pediatr 108:439–47 (1986).CrossRefGoogle Scholar
  50. 50.
    Kildeberg P, Engel K, Winters RW. Balance of net acid in growing infants. Endogenous and transintestinal aspects. Acta Paediatr Scand 58:321–9 (1969).CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1987

Authors and Affiliations

  • Jacques Senterre
    • 1
  1. 1.Department of PediatricsState University of Liège Hôpital de la CitadelleLiègeBelgium

Personalised recommendations