Neonatology pp 639-668 | Cite as

Calcium and Phosphorus Homeostasis: Pathophysiology

  • Jacques Rigo
  • Catherine Pieltain
  • Renaud Viellevoye
  • Franco Bagnoli
Reference work entry


The metabolic homeostasis of calcium, phosphorus, and magnesium and mineralization of the skeleton are complex functions that require adequate supply of nutrients, the development of the intestinal absorption process, the interaction of several hormones (such as parathyroid hormone, vitamin D, and calcitonin), and optimum renal and skeletal control. Approximately 50% of total serum calcium is in ionized form at the normal serum protein concentration and represents the biologically active component of the total serum calcium concentration. The fetus maintains higher blood calcium and phosphorus levels than the ambient maternal levels. This process is the result of the active transport of calcium across the placenta. The role of vitamin D in fetal physiology is not well understood. Calcium absorption is the main determinant of its retention in the small intestine by both active and passive processes. Acid pH in the stomach is a prerequisite for absorption. Reference values of calcium retention calculated during the last trimester of gestation (120–130 mg/kg/day) are considered the target mineral accretion rates for infants with very low birth weight. We should pay particular attention to the dosage of total and ionized serum calcium when some medications are used or when there is acidosis/alkalosis, hypomagnesemia, prematurity, infant of a diabetic mother, or birth asphyxia. In contrast to calcium, the serum phosphorus concentration varies widely depending mainly on intake and renal excretion but is also influenced by age, gender, pH, and a variety of hormones. Premature infants, particularly those born at <28 weeks’ gestation, are at significant risk for reduced bone mineral content (BMC) and subsequent bone disease, variably termed metabolic bone disease (MBD), osteomalacia, osteopenia, or neonatal rickets. Several factors increase the risk for severe MBD among VLBW infants, with the most important appearing to be an inadequate supply of calcium and phosphorus associated with the use of an enteral vs. transplacental route. Early optimal parenteral and oral nutritional support, combined with biologic neonatal screening and biomarker measurements, appears to be helpful for the prevention of MBD.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jacques Rigo
    • 1
  • Catherine Pieltain
    • 1
  • Renaud Viellevoye
    • 1
  • Franco Bagnoli
    • 2
  1. 1.Department of NeonatologyUniversity of Liège, CHR de la CitadelleLiègeBelgium
  2. 2.Department of PediatricsObstetrics and Reproductive Medicine, University of SienaSienaItaly

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