Calcium supplements and you may Vitamin D Requirements from Enterally Provided Preterm Babies Leave a comment

Calcium supplements and you may Vitamin D Requirements from Enterally Provided Preterm Babies

Steven An excellent. Abrams, the fresh new Panel On the Nourishment, Jatinder J. S. Bhatia, Steven A beneficial. Abrams, Draw Roentgen. Corkins, Sarah D. de- Ferranti, Neville H. Wonderful, from inside the D Requirements away from Enterally Fed Preterm Infants. Pediatrics -0420

Calcium and you will Vitamin D Requirements from Enterally Fed Preterm Children

Bone health is a critical concern in managing preterm infants. Key nutrients of importance are calcium, vitamin D, and phosphorus. Although human milk is critical for the health of preterm infants, it is low in these nutrients relative to the needs of the infants during growth. Strategies should be in place to fortify human milk for preterm infants with birth weight <1800 to 2000 g and to ensure adequate mineral intake during hospitalization and after hospital discharge. Biochemical monitoring of very low birth weight infants should be performed during their hospitalization. Vitamin D should be provided at 200 to 400 IU/day both during hospitalization and after discharge from the hospital. Infants with radiologic evidence of rickets should have efforts made to maximize calcium and phosphorus intake by using available commercial products and, if needed, direct supplementation with these minerals.

Last year, the latest Institute away from Drug (IOM) put-out weightloss direction to own calcium supplements and you will vitamin D intakes for everyone age range. step 1 But not, no consumption pointers have been made specifically for preterm kids, as they was in fact considered a unique populace and you can don’t match from inside the advice to have diet site intakes produced by the brand new IOM. Preterm babies has book limbs mineral standards that may never be believed getting just like those of complete-label infant kids. Earlier in the day comments in the usa don’t have a lot of their guidance so you can full-name children. dos , step three Yet not, The fresh new European People to have Pediatric Gastroenterology, Hepatology, and you will Nutrition has recently demonstrated enteral nutrients ideas for preterm infants. cuatro , 5

Study on in utero bone mineralization costs is minimal. Cadaver training, beginning with the newest vintage performs off Widdowson ainsi que al, 6 essentially service an in utero accretion of calcium when you look at the 3rd trimester out-of 100 to help you 130 milligrams/kg everyday, peaking between thirty-two and you will 36 weeks’ gestation. Phosphorus accretion is roughly 1 / 2 of the newest accretion off calcium supplements during gestation. Interestingly, newer reevaluation of them research that with modern looks composition process dominicancupid promosyon kodu Гјcretsiz eight considering viewpoints like the individuals developed by Widdowson et al. 6

In full-term infants, there is a strong correlation between maternal and infant cord blood 25-hydroxyvitamin D (25-OH-D) concentrations, although the cord blood concentration is less than the maternal concentration. 8 A substantial proportion of pregnant women, especially African American and Hispanic women in the United States and Europe, have 25-OH-D concentrations <20 ng/mL (50 nmol/L), 9 a value set for the basis of the Recommended Dietary Allowance. 1 However, in utero, skeletal mineralization is priin D status, making the clinical significance of 25-OH-D concentrations during pregnancy unclear. 10 , 11

Negative effects of Preterm Birth on the Mineral Metabolism

Population-based studies of rickets among preterm infants are lacking; therefore, the frequency is not known or reliably estimated. Approximately 10% to 20% of hospitalized infants with birth weight <1000 g have radiographically defined rickets (metaphyseal changes) despite current nutritional practices. 12 This frequency is much lower than the 50% incidence in this population described before fortification of human milk and the use of preterm high mineral containing formulas were routine. 13 One challenge in identifying the prevalence of rickets is the confusion related to terminology. Rickets is defined by radiographic findings, not by any biochemical findings. Standard radiographic definitions of rickets are used. Poorly defined terms, such as osteopenia or biochemical rickets, are often used in the literature interchangeably with radiographically defined rickets. Rickets is not widely reported in preterm infants with birth weight >1500 g unless there are health issues severely limiting enteral nutrition.


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