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Llorente-Pelayo S, Docio P, Arriola S, Lavín-Gómez BA, García-Unzueta MT, Ballesteros MÁ, Cabero-Pérez MJ, González-Lamuño D. Role of fibroblast growth factor-23 as an early marker of metabolic bone disease of prematurity. BMC Pediatr 2024; 24:418. [PMID: 38951759 PMCID: PMC11218264 DOI: 10.1186/s12887-024-04897-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/19/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE Metabolic bone disease of prematurity (MBDP) remains a significant cause of morbidity in extremely premature newborns. In high-risk patients, suspected diagnosis and subsequent treatment modifications, with limitations in terms of sensitivity and specificity, rely on low phosphorus levels and/or high levels of alkaline phosphatase (ALP). We investigated the potential of fibroblast growth factor-23 (FGF23) as an early marker for MBDP when measured at 3-4 weeks of life in at-risk patients. METHODS A single-center prospective observational non-interventional study including preterm newborns of both sexes, with a gestational age of less than 32 weeks and/or a birth weight of less than 1500 g. In the standard biochemical screening for MBDP performed between 3 and 4 weeks of life within a nutritional profile, the determination of FGF23 was included along with other clinical and metabolic studies. The study was conducted at Marqués de Valdecilla University Hospital in Santander, Spain, from April 2020 to March 2021. Participants provided informed consent. Biochemical analyses were conducted using various platforms, and follow-up evaluations were performed at the discretion of neonatologists. Patients at high risk for MBDP received modifications in treatment accordingly. The sample was descriptively analyzed, presenting measures of central tendency and dispersion for continuous variables, and absolute numbers/percentages for categorical ones. Tests used included t-tests, Mann‒Whitney U tests, chi-square tests, logistic regressions, Pearson correlation, and ROC curve analysis (IBM SPSS Statistics version 19). Significance level: P < 0.05. RESULTS In the study involving 25 at-risk premature newborns, it was found that 20% (n = 5) were diagnosed with MBDP. Three of these patients (60%) were identified as high-risk based on standard biochemical evaluation at 3-4 weeks of age, while the other two patients (40%) were diagnosed in subsequent weeks. However, in all 5 patients, measurement of FGF23 levels would allow for early identification and optimization of treatment before other markers become altered. Low levels of FGF23 at 3-4 weeks, even with normal phosphorus and ALP levels, indicate the need for modifications in nutritional supplementation. CONCLUSIONS MBDP remains a significant concern in extremely premature newborns. Current diagnostic methods rely on limited biochemical markers. Early detection of low FGF23 levels enables timely interventions, potentially averting demineralization.
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Affiliation(s)
- Sandra Llorente-Pelayo
- Pediatric Department, University Hospital Marqués de Valdecilla-Research Institute Valdecilla (IDIVAL), Santander, 39008, Spain
| | - Pablo Docio
- Pediatric Department, University Hospital Marqués de Valdecilla-Research Institute Valdecilla (IDIVAL), Santander, 39008, Spain
| | - Silvia Arriola
- Neonatology Unit, Pediatric Department, University Hospital Marqués de Valdecilla-Research Institute Valdecilla (IDIVAL), Santander, 39008, Spain
| | - Bernardo A Lavín-Gómez
- Biochemical Department, University Hospital Marqués de Valdecilla-Research Institute Valdecilla (IDIVAL), Santander, 39008, Spain
| | - María T García-Unzueta
- Biochemical Department, University Hospital Marqués de Valdecilla-Research Institute Valdecilla (IDIVAL), Santander, 39008, Spain
| | - María Ángeles Ballesteros
- Department of Critical Care Medicine, Hospital Marqués de Valdecilla-IDIVAL, Avda Valdecilla s/n, Santander, 39008, Spain
| | - María J Cabero-Pérez
- Pediatric Department, University Hospital Marqués de Valdecilla-Research Institute Valdecilla (IDIVAL), Santander, 39008, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, University of Cantabria, Santander, 39005, Spain
| | - Domingo González-Lamuño
- Pediatric Department, University Hospital Marqués de Valdecilla-Research Institute Valdecilla (IDIVAL), Santander, 39008, Spain.
- Departamento de Ciencias Médicas y Quirúrgicas, University of Cantabria, Santander, 39005, Spain.
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Malone Jenkins S, Chan G, Weaver-Lewis K, Bardsley T, Felix J, Grinsell M. Vitamin D, bone density, and nephrocalcinosis in preterm infants: a prospective study. Pediatr Nephrol 2022; 37:1325-1332. [PMID: 34595571 DOI: 10.1007/s00467-021-05300-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vitamin D (VitD) supplementation is recommended by the American Academy of Pediatrics (AAP) for preterm infants to improve bone density. Complications of VitD supplementation include hypercalciuria and nephrocalcinosis (NC). NC has been reported in 7-64% infants < 32 weeks gestational age (GA) or < 1500 g birth weight (BW). The relationships between VitD supplementation, serum 25-hydroxy VitD levels, bone density, hypercalciuria and development of NC in preterm infants are not well established. METHODS Prospective, observational cohort study of 56 infants with GA ≤ 32 weeks or BW ≤ 1800 g. Demographics, dietary intakes, serum 25-hydroxy VitD levels and weekly urinalyses were collected until 40 weeks corrected GA or discharge. Bone mineral density (BMD) and content (BMC) were assessed using dual-energy X-ray absorptiometry (DEXA) scan. NC was identified by kidney ultrasound. RESULTS 56 infants received on average 447 IU/day of VitD with average serum 25-hydoxy VitD level 39.6 ng/mL. DEXA scan showed average BMD 0.13 g/cm2 and BMC 35.8 g. 23/56 (41%) infants were diagnosed with NC. Infants with NC had lower GA (p < 0.01) and BW (p < 0.01) and increased presence of calcium oxalate crystals (78% vs. 36%) (p = 0.002). There were no differences in VitD intake, urine calcium/creatinine ratios or BMD and BMC in infants with versus without NC. CONCLUSIONS VitD supplementation per AAP guidelines resulted in acceptable serum 25-hydroxyVitD levels, but no improvement in BMD or BMC compared to previously reported values. However, infants receiving recommended amounts born at earlier GA and lower BW are at increased risk of NC. VitD supplementation and serum levels should be closely monitored in this high-risk population. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Sabrina Malone Jenkins
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Gary Chan
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Tyler Bardsley
- CCTS Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA
| | - Jace Felix
- University of Utah, Salt Lake City, UT, USA
| | - Matthew Grinsell
- Division of Nephrology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Pouch GG, Ebeling M, Shary JR, Hollis BW, Howard CR, Wagner CL. Evaluating Vitamin D Status in Infants Less than Seven Months; What Are the Preferred Biochemical Measurements? Breastfeed Med 2022; 17:422-428. [PMID: 35196139 PMCID: PMC9271327 DOI: 10.1089/bfm.2021.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: To ensure the safety of higher dose vitamin D supplementation in pregnant and lactating mothers, and urinary calcium/creatinine (UCa/Cr) ratios, serum calcium, and serum 25(OH)D concentrations are closely monitored. To achieve optimal maternal and infant vitamin D status, while avoiding hypercalcemia, safety measures assessing vitD supplementation must be reliable. Whether or not this holds true for infants before 7 months of age, remains unknown. Objective: Analyze the association among UCa/Cr ratio, serum calcium, intact serum parathyroid hormone (iPTH), 25(OH)D, and 25(OH)D/iPTH ratio in infants to determine whether evidence supports the use of these parameters as valuable measures of hypervitaminosis D or toxicity in infants. Methods: A series of analyses were performed on the cohort of infants who participated in the National Institute of Child Health and Human Development lactation vitD supplementation trial to determine the association among UCa/Cr ratio, serum calcium, iPTH, 25(OH)D, and 25(OH)D/iPTH ratio. Results: Upon multivariate analysis, serum calcium was significantly associated with 25(OH)D (p = 0.0441), iPTH (p = 0.0017), and 25(OH)D/iPTH ratio (p = 0.0001). Infant UCa/Cr did not associate with 25(OH)D but did associate with iPTH (p = 0.0008) and 25(OH)D/iPTH ratio (p = 0.0001). The correlation between UCa/Cr and 25(OH)D/iPTH ratios was significantly stronger than the association between UCa/Cr ratio and iPTH. Serum calcium more strongly correlated with 25(OH)D/iPTH ratio versus 25(OH)D and iPTH. Conclusion: In this healthy cohort of infants 1 to 7 months old, UCa/Cr and serum calcium are more valid indicators of 25(OH)D/iPTH ratio than either 25(OH)D or iPTH alone. Moreover, serum calcium (and not UCa/Cr) is a valid indicator of infant total circulating 25(OH)D and should be measured if vitamin D toxicity is a concern. Clinical Trial Registration number: FDA IND Number: 66,346; ClinicalTrials.gov Number: NCT00412074.
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Affiliation(s)
- Grace G Pouch
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Myla Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Cynthia R Howard
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
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Thanh LQ, Chen Y, Hartweg M, Thi Nguyen TA. Effects of higher protein formula with improved fat blend on growth, feeding tolerance and nutritional biomarkers in preterm infants: A double-blind, randomized, controlled clinical trial. Pediatr Neonatol 2022; 63:227-238. [PMID: 35000893 DOI: 10.1016/j.pedneo.2021.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preterm formulas containing greater protein:energy ratio are beneficial for non-breastfed infants, since protein is critical for promoting catch-up growth and synthesis of lean body mass. Additionally, formulas containing enriched sn-2 palmitate (sn-2) and reduced medium chain triglycerides (MCTs) may support better feeding tolerance and nutrient utilization. METHODS The objective of this randomized, controlled, double-blinded clinical trial is to evaluate growth, feeding tolerance and nutritional biomarkers of preterm infants with birth weight ≤2000g and gestational age ≤33wks from one neonatal unit in Vietnam receiving experimental formula (EF, n = 80) containing higher protein level of 3.4 g/100 kcal and improved fat blend with enriched sn-2 and modified level of MCTs or isocaloric control formula (CF, n = 80) containing protein level of 2.9 g/100 kcal and standard fat blend. The differences in weight gain (g/d; primary endpoint) from day 1 (D1) of full enteral feeding (FEF) until D21 between groups was evaluated for non-inferiority (margin = -2.5 g/d) and superiority (margin = 0 g/d). RESULTS Mean weight gain was 3.09 g/d greater in EF than CF; the lower limit of 95% CI (0.31 g/d) exceeded both non-inferiority and superiority margins. There was no significant difference in length-for-age and head circumference-for-age z-score. By D79, the mean change in weight-for-age z-scores from D1 in EF group (+0.76 SDs) surpassed the criteria for catch-up growth (+0.67 SDs). Infants in the EF group (vs. CF) tended to have softer stools (EF = 3.2 ± 0.59 vs. CF = 3.4 ± 0.58; P = 0.07) based on 5-point scale (1 = watery, 5 = hard). Difference in blood urea nitrogen and biomarkers for bone mineral status (i.e., plasma phosphorus, alkaline phosphatase and urinary calcium/phosphorus ratio) between EF and CF on FEF Day 21 reached statistical significance (P < 0.05) but all mean values stayed within normal clinical ranges for both groups. CONCLUSION Preterm formula with greater protein:energy ratio and new fat blend is safe, nutritionally suitable, well-tolerated, and improves catch-up weight gain of preterm infants. Clinical trial registry identifier is NCT03055052 (ClinicalTrials.gov).
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Affiliation(s)
| | - Yipu Chen
- Nestlé Product Technology Center - Nutrition, Société des Produits Nestlé SA, Vevey, Switzerland.
| | - Mickaël Hartweg
- Clinical Development Unit, Nestlé Research, Lausanne, Switzerland
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Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial. Nutrients 2021; 13:nu13103442. [PMID: 34684442 PMCID: PMC8537871 DOI: 10.3390/nu13103442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022] Open
Abstract
Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n = 55; approximately 800–1000 IU from combined sources) or monitored therapy (n = 54; with an option of dose modification). 25-hydroxyvitamin D [25(OH)D] concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52 ± 2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20–80 ng/mL) at 52 weeks of PCA (p = 0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.
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Kołodziejczyk A, Borszewska-Kornacka MK, Seliga-Siwecka J. MOnitored supplementation of VItamin D in preterm infants (MOSVID trial): study protocol for a randomised controlled trial. Trials 2017; 18:424. [PMID: 28893306 PMCID: PMC5594536 DOI: 10.1186/s13063-017-2141-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022] Open
Abstract
Background The pivotal role of vitamin D (vit D) in skeletal health is well known. Neonatal vit D storage at birth is dependent on maternal levels, and newborns receive 50–70% of their mother’s 25-hydroxyvitamin D [25(OH)D]. Deficiency of vit D can lead to prematurity bone disease, with an incidence of up to 55% in infants weighing < 1000 g. The aim of this study is to assess the effectiveness of monitored supplementation of vit D in a population of preterm infants. Methods/design Preterm infants born at 24–32 weeks of gestation will be recruited within the first 7 days of life. Depending on the type of feeding, and after reaching partial enteral feeding or at 7 days of life, vit D supplementation will consist of 500 IU and an additional 150–300 IU/kg included in human milk fortifiers (if fed exclusively with breast milk) or 190 IU/kg in milk formulas. Subjects will be randomised to either monitored (with an option of dose modification based on 25(OH)D levels as per protocol) or standard therapy up to 52 weeks of post-conceptional age (PCA). The primary outcome measure will be the number of neonates with deficiency or excess levels of 25(OH)D at 40 ±2 weeks of PCA. Additional 25(OH)D levels will be measured at birth, at 4 and 8 weeks of age, and/or at 35 and 52 ±2 weeks of PCA. Secondary objectives will include the incidence of osteopenia, nephrocalcinosis and nephrolithiasis. Serum parameters of calcium phosphorus metabolism will also be measured. Discussion Despite multiple years of research and numerous publications, there is still a lack of consensus in regard to how much vit D infants should receive and how long they should receive it. Because 80% of calcium and phosphorus placental transfer occurs between 24 and 40 weeks of gestation, preterm infants are especially prone to adverse effects of vit D insufficiency. However, both inadequate and excessive amounts of vit D may be unsafe and lead to serious health issues. The results of our study may shed new light on these concerns and contribute to optimising vit D supplementation. Trial registration ClinicalTrials.gov, NCT03087149. Registered on 15 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2141-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alicja Kołodziejczyk
- Neonatal and Intensive Care Department, Medical University of Warsaw, Karowa 2 Street, 00-315, Warsaw, Poland
| | - Maria K Borszewska-Kornacka
- Neonatal and Intensive Care Department, Medical University of Warsaw, Karowa 2 Street, 00-315, Warsaw, Poland
| | - Joanna Seliga-Siwecka
- Neonatal and Intensive Care Department, Medical University of Warsaw, Karowa 2 Street, 00-315, Warsaw, Poland.
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Christmann V, Gradussen CJW, Körnmann MN, Roeleveld N, van Goudoever JB, van Heijst AFJ. Changes in Biochemical Parameters of the Calcium-Phosphorus Homeostasis in Relation to Nutritional Intake in Very-Low-Birth-Weight Infants. Nutrients 2016; 8:nu8120764. [PMID: 27916815 PMCID: PMC5188419 DOI: 10.3390/nu8120764] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/13/2016] [Accepted: 11/24/2016] [Indexed: 11/19/2022] Open
Abstract
Preterm infants are at significant risk to develop reduced bone mineralization based on inadequate supply of calcium and phosphorus (Ca-P). Biochemical parameters can be used to evaluate the nutritional intake. The direct effect of nutritional intake on changes in biochemical parameters has not been studied. Our objective was to evaluate the effect of Ca-P supplementation on biochemical markers as serum (s)/urinary (u) Ca and P; alkaline phosphatase (ALP); tubular reabsorption of P (TrP); and urinary ratios for Ca/creatinin (creat) and P/creatinin in Very-Low-Birth-Weight infants on Postnatal Days 1, 3, 5, 7, 10, and 14. This observational study compared two groups with High (n = 30) and Low (n = 40) intake of Ca-P. Birth weight: median (IRQ) 948 (772–1225) vs. 939 (776–1163) grams; and gestational age: 28.2 (26.5–29.6) vs. 27.8 (26.1–29.4) weeks. Daily median concentrations of biochemical parameter were not different between the groups but linear regression mixed model analyses showed that Ca intake increased the uCa and TrP (p = 0.04) and decreased ALP (p = 0.00). Phosphorus intake increased sP, uP and uP/creat ratio and ALP (p ≤ 0.02) and caused decrease in TrP (p = 0.00). Protein intake decreased sP (p = 0.000), while low gestational age and male gender increased renal excretion of P (p < 0.03). Standardized repeated measurements showed that biochemical parameters were affected by nutritional intake, gestational age and gender.
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Affiliation(s)
- Viola Christmann
- Department of Paediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen 6500HB, The Netherlands.
| | - Charlotte J W Gradussen
- Department of Paediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen 6500HB, The Netherlands.
| | - Michelle N Körnmann
- Department of Paediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen 6500HB, The Netherlands.
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen 6500HB, The Netherlands.
- Department of Paediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen 6500HB, The Netherlands.
| | - Johannes B van Goudoever
- Department of Paediatrics, VU university medical center Amsterdam, Amsterdam 1081HV, The Netherlands.
- Department of Paediatrics, Emma Children's Hospital-AMC Amsterdam, Amsterdam 1105AZ, The Netherlands.
| | - Arno F J van Heijst
- Department of Paediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen 6500HB, The Netherlands.
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Dowa Y, Kawai M, Kanazawa H, Iwanaga K, Matsukura T, Heike T. Screening for secondary hyperparathyroidism in preterm infants. Pediatr Int 2016; 58:988-992. [PMID: 26916393 DOI: 10.1111/ped.12961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 01/25/2016] [Accepted: 02/19/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The major cause of osteopathy of prematurity is dietary phosphate deficiency, but secondary hyperparathyroidism caused by calcium deficiency or vitamin D deficiency is also important. Because parathyroid hormone (PTH) mobilizes calcium and phosphate from the bone, hyperparathyroidism worsens osteopathy of prematurity. In order to identify useful markers to screen for and diagnose hyperparathyroidism in preterm infants, we measured serum and urinary biochemical markers. METHODS Several biomarkers, including serum intact PTH (iPTH), were measured in urine and serum samples obtained from 95 preterm infants, and the relationship between serum iPTH and the other parameters was analyzed. RESULTS Mean gestation was 33.2 ± 2.9 weeks, and mean birthweight was 1705 ± 402 g. Samples were collected around postnatal day 17.3 ± 7.4. Fourteen infants (14.7%) had iPTH >65 pg/mL. Cut-offs for serum alkaline phosphatase (ALP) and percent tubular reabsorption rate of phosphate (%TRP) were fixed at 1300 IU/L and 93%, respectively using receiver operating characteristic curves with iPTH cut-off of 65 pg/mL. Serum ALP was proven to be a good marker: ALP had a sensitivity of 78.6% and a specificity of 86.4%, while %TRP itself was not: %TRP had a sensitivity of 64.3% and a specificity of 58.0%. Combined measurement of serum ALP (>1300 IU/L) and %TRP (≤93%), however, had a specificity of 93.8% for detecting elevated iPTH. CONCLUSION Measurement of serum ALP (>1300 IU/L) is considered as an effective screening method to detect hyperparathyroidism. In addition, combined assessment of ALP(>1300 IU/L) and %TRP(≤93%) is a good indicator of elevated iPTH in preterm infants.
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Affiliation(s)
- Yuri Dowa
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hoshinori Kanazawa
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kougoro Iwanaga
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Matsukura
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshio Heike
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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9
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A randomized double-blind controlled trial comparing two regimens of vitamin D supplementation in preterm neonates. J Perinatol 2016; 36:763-7. [PMID: 27149055 DOI: 10.1038/jp.2016.70] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/16/2016] [Accepted: 03/28/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the efficacy of 400 vs 1000 IU oral vitamin D supplementation in preterm neonates of 27 to 34 weeks gestation. METHODS This double-blind randomized controlled trial allocated preterm babies to receive either 400 or 1000 IU of vitamin D3 (n=60 in each group). Primary outcome was prevalence of vitamin D insufficiency (serum vitamin D levels<20 ng ml(-1)) at 40 weeks of corrected gestational age (CGA). RESULTS At term CGA vitamin D insufficiency was significantly lower in the 1000 IU group than in the 400 IU group (2% vs 64.6%, P⩽0.001). Although elevated vitamin D levels were seen in 9.8% of babies on 1000 IU per day, this was not associated with clinical or biochemical evidence of toxicity. CONCLUSION Supplementing preterm babies with 1000 IU of vitamin D3 daily decreases the prevalence of vitamin D insufficiency at term CGA. Excess levels of vitamin D may occur at this dose in some babies.
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Postnatal Changes in Humerus Cortical Bone Thickness Reflect the Development of Metabolic Bone Disease in Preterm Infants. DISEASE MARKERS 2016; 2016:2176594. [PMID: 27194819 PMCID: PMC4852355 DOI: 10.1155/2016/2176594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/10/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2022]
Abstract
Objective. To use cortical bone thickness (CBT) of the humerus to identify risk factors for the development of metabolic bone disease in preterm infants. Methods. Twenty-seven infants born at <32 weeks of gestational age, with a birth weight of <1,500 g, were enrolled. Humeral CBT was measured from chest radiographs at birth and at 27-28, 31-32, and 36-44 weeks of postmenstrual age (PMA). The risk factors for the development of osteomalacia were statistically analyzed. Results. The humeral CBT at 36-44 weeks of PMA was positively correlated with gestational age and birth weight and negatively correlated with the duration of mechanical ventilation. CBT increased with PMA, except in six very early preterm infants in whom it decreased. Based on logistic regression analysis, gestational age and duration of mechanical ventilation were identified as risk factors for cortical bone thinning. Conclusions. Humeral CBT may serve as a radiologic marker of metabolic bone disease at 36-44 weeks of PMA in preterm infants. Cortical bones of extremely preterm infants are fragile, even when age is corrected for term, and require extreme care to lower the risk of fractures.
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Meneghelli M, Pasinato A, Salvadori S, Gaio P, Fantinato M, Vanzo V, De Terlizzi F, Verlato G. Bone status in preterm infant: influences of different nutritional regimens and possible markers of bone disease. J Perinatol 2016; 36:394-400. [PMID: 26765552 DOI: 10.1038/jp.2015.212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/15/2015] [Accepted: 11/23/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate possible influences of parenteral nutrition on growth and bone development in preterms and to search for markers of bone status. STUDY DESIGN Metacarpus bone transmission time (mc-BTT) was performed at birth, 21 days and 36 weeks of gestational age (GA) in preterms, receiving two different nutritional regimens, together with biochemical analysis. RESULT A total of 234 patients were studied. Newborns with aggressive nutrition had significantly better growth rate and higher values of mc-BTT until discharge. Mc-BTT at day 21 correlates positively with nutritional intakes and phosphatemia; lower limb length positively correlated with mc-BTT (P<0.01). Newborns with low energy intake in the first week of life (<70 kcal kg(-1) per day) and low serum phosphate level (<1.4 mmol l(-1)) at 21 days had lower mc-BTT at 36 weeks of GA (P<0.01). CONCLUSION Aggressive parenteral intakes in preterms improve growth and bone status in the short-medium term, suggesting that early nutrition could influence bone development.
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Affiliation(s)
- M Meneghelli
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - A Pasinato
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - S Salvadori
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - P Gaio
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - M Fantinato
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - V Vanzo
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - F De Terlizzi
- Laboratory of Clinical Biophysics, IGEA, Modena, Italy
| | - G Verlato
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
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Rehman MU, Narchi H. Metabolic bone disease in the preterm infant: Current state and future directions. World J Methodol 2015; 5:115-121. [PMID: 26413483 PMCID: PMC4572023 DOI: 10.5662/wjm.v5.i3.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/15/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretics or corticosteroids, and those with neuromuscular disorders. Complications such as rickets, pathological fractures, impaired respiratory function and poor growth in childhood can develop and may be the first clinical evidence of the condition. It is important for neonatologists managing such high-risk patients to regularly monitor biochemical markers for evidence of abnormal bone turnover and inadequate mineral intake in order to detect the early phases of impaired bone mineralization. Dual-energy X-ray absorptiometry has become an increasingly used research tool for assessing bone mineral density in children and neonates, but more studies are still needed before it can be used as a useful clinical tool. Prevention and early detection of osteopenia are key to the successful management of this condition and oral phosphate supplements should be started as soon as is feasible.
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Kelly A, Kovatch KJ, Garber SJ. Metabolic bone disease screening practices among U.S. neonatologists. Clin Pediatr (Phila) 2014; 53:1077-83. [PMID: 24872339 DOI: 10.1177/0009922814535661] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Preterm, low-birth-weight neonates are predisposed to metabolic bone disease (MBD). This survey aimed to assess screening, diagnostic, and treatment practices in U.S. level IIIB/IIIC neonatal intensive care units (NICUs). A 29-question anonymous online survey was e-mailed to American Academy of Pediatrics Perinatal Section members. 338 neonatologists, representing 246 IIIB/IIIC NICUs, responded. 86% reported MBD screening. Screening was primarily based on gestational age (71%), with thresholds <26 to <36 weeks. Other criteria included birth weight (64%), total parenteral nutrition duration (48%), X-ray findings (56%), diuretic use (41%), and exclusive breast-feeding (9.6%). Almost universally, diagnosis was based on elevated alkaline phosphatase, most commonly >500 U/L (58.6%). 52% used X-ray for diagnosis. Treatment included human milk fortification (83%), vitamin D (67%), calcium (65%), and phosphorus (65%) supplementation. Our survey confirms widespread awareness of MBD but highlights lack of consensus regarding definition, screening, and treatment. Further research is needed to develop and optimize strategies to prevent, recognize, and manage MBD.
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Affiliation(s)
- Andrea Kelly
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin J Kovatch
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel J Garber
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA Pennsylvania Hospital, Philadelphia, PA, USA
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14
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Abstract
Microscopic and gross hematuria, while rare in healthy newborns, is more common in premature infants, particularly those cared for in the neonatal intensive care unit. Hematuria may be transient, but may require evaluation, investigation, and intervention in a timely manner. This article discusses the causes, workup, and treatment of the more common forms of newborn hematuria.
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15
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Monitoring of urinary calcium and phosphorus excretion in preterm infants: comparison of 2 methods. J Pediatr Gastroenterol Nutr 2014; 58:404-8. [PMID: 24253368 DOI: 10.1097/mpg.0000000000000244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Premature babies require supplementation with calcium (Ca) and phosphorus (P) to prevent metabolic bone disease of prematurity. To guide mineral supplementation, 2 methods of monitoring urinary excretion of Ca and P are used: urinary Ca or P concentration and Ca/creatinine (Crea) or P/Crea ratios. We compare these 2 methods in regards to their agreement on the need for mineral supplementation. METHODS Retrospective chart review of 230 premature babies with birth weight <1500 g, undergoing screening of urinary spot samples from day 21 of life and fortnightly thereafter. Hypothetical cutoff values for urine Ca or P concentration (1 mmol/L) and urine Ca/Crea ratio (0.5 mol/mol) or P/Crea ratio (4 mol/mol) were applied to the sample results. The agreement on whether to supplement the respective minerals based on the results with the 2 methods was compared. Multivariate general linear models sought to identify patient characteristics to predict discordant results. RESULTS A total of 24.8% of cases did not agree on the indication for Ca supplementation, and 8.8% for P. Total daily Ca intake was the only patient characteristic associated with discordant results. CONCLUSIONS With the intention to supplement the respective mineral, comparison of urinary mineral concentration with mineral/Crea ratio is moderate for Ca and good for P. The results do not allow identifying superiority of either method on the decision as to which babies require Ca and/or P supplements.
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Abstract
OBJECTIVES Bone mineralisation in preterm infants is related to the supply of calcium (Ca) and phosphorus (P). We increased the amount of minerals in parenteral nutrition (PN) for preterm infants and evaluated postnatal Ca and P metabolism in relation to mineral and vitamin D (vitD) intake. METHODS Preterm infants, included on their first day of life, received standard PN, providing a maximum Ca/P intake of 3/1.92 mmol · kg(-1) · day(-1) on day 3. Ca/P content of formula was 2.5/1.6 mmol/dL, and fortified human milk was 2.4/1.95 mmol/dL. PN supplied 80 IU · kg(-1) · day(-1) vitD. Formula and fortified human milk contained 200 IU/dL of vitD. During a 5-week period, serum concentrations and urinary excretion of Ca/P were registered and related to the intake of minerals and vitD. RESULTS During 12 months, 79 infants (mean gestational age 29.8 ± 2.2 weeks, mean birth weight 1248 ± 371 g) were included. The recommended intake for minerals was achieved by day 5 and for vitD by 4 weeks. Infants developed hypercalcaemia, hypercalciuria, and hypophosphataemia during the first postnatal week, leading to the additional P supplementation in 49 infants. The renal tubular reabsorption of P was >95% until day 9 but decreased <70% after the second week. Alkaline phosphatase was normal at birth, increased to a maximum of 450 IU/L by day 14, and remained above the normal range for the remaining period. CONCLUSIONS Parenteral intake of P appeared to be too low, leading to mineral imbalances in the early postnatal period, and vitD intake was also below recommendations.
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Natarajan CK, Sankar MJ, Agarwal R, Pratap OT, Jain V, Gupta N, Gupta AK, Deorari AK, Paul VK, Sreenivas V. Trial of daily vitamin D supplementation in preterm infants. Pediatrics 2014; 133:e628-34. [PMID: 24515510 DOI: 10.1542/peds.2012-3395] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the effect of 800 vs 400 IU of daily oral vitamin D3 on the prevalence of vitamin D deficiency (VDD) at 40 weeks' postmenstrual age (PMA) in preterm infants of 28 to 34 weeks' gestation. METHODS In this randomized double-blind trial, we allocated eligible infants to receive either 800 or 400 IU of vitamin D3 per day (n = 48 in both groups). Primary outcome was VDD (serum 25-hydroxyvitamin D levels <20 ng/mL) at 40 weeks' PMA. Secondary outcomes were VDD, bone mineral content, and bone mineral density at 3 months' corrected age (CA). RESULTS Prevalence of VDD in the 800-IU group was significantly lower than in the 400-IU group at 40 weeks (38.1% vs. 66.7%; relative risk: 0.57; 95% confidence interval: 0.37-0.88) and at 3 months' CA (12.5% vs. 35%; relative risk: 0.36; 95% confidence interval: 0.14-0.90). One infant (2.4%) in the 800-IU group had vitamin D excess (100-150 ng/mL). Bone mineral content (mean ± SD: 79.6 ± 16.8 vs. 84.7 ± 20.7 g; P = .27) and bone mineral density (0.152 ± 0.019 vs. 0.158 ± 0.021 g/cm2; P = .26) were not different between the 2 groups. CONCLUSIONS Daily supplementation with 800 IU of vitamin D reduces the prevalence of VDD at 40 weeks' PMA and at 3 months' CA in preterm infants without showing any improvement in bone mineralization. However, there is a possibility that this dose may occasionally result in vitamin D excess.
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18
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Betto M, Gaio P, Ferrini I, De Terlizzi F, Zambolin M, Scattolin S, Pasinato A, Verlato G. Assessment of bone health in preterm infants through quantitative ultrasound and biochemical markers. J Matern Fetal Neonatal Med 2013; 27:1343-7. [PMID: 24215624 DOI: 10.3109/14767058.2013.858317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess bone status in preterm infants with quantitative ultrasound and to search for biochemical markers of bone health. METHODS Metacarpus bone transmission time (mcBTT) was prospectively performed during hospitalization, together with biochemical and clinical outcomes analysis. RESULTS 154 patients were studied. At 3rd week of life mcBTT positively correlated with serum phosphate. Urinary excretion of calcium and phosphate were assessed in a subgroup of 55 patients: on day 21 mcBTT positively correlated with phosphaturia, negatively with calciuria. Gestational age (GA), weight and length at 3rd week and at 36 weeks of GA correlated positively with mcBTT. We found negative correlation between mcBTT at 3rd week and days of parenteral nutrition, mechanical ventilation period and days to reach 1800 g. CONCLUSIONS Serum phosphate, phosphaturia and calciuria correlate most with mcBTT. Further studies are necessary to verify the possible influence of early bone status on future bone health.
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Affiliation(s)
- Martina Betto
- Women's and Children's Health Department, University of Padova , Padova , Italy and
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19
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Identification of Fracture Risk and Strategies for Bone Health in the Neonatal Intensive Care Unit. TOP CLIN NUTR 2012. [DOI: 10.1097/tin.0b013e318262d434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Visser F, Sprij AJ, Brus F. The validity of biochemical markers in metabolic bone disease in preterm infants: a systematic review. Acta Paediatr 2012; 101:562-8. [PMID: 22313336 DOI: 10.1111/j.1651-2227.2012.02626.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
UNLABELLED To establish the validity of biochemical markers of metabolic bone disease (MBD) in preterm infants. CONCLUSION There is insufficient evidence that any of the frequently used serum measurements are valid biochemical markers of MBD in preterm infants. Increased urinary calcium concentration may be a valid biochemical marker, but more research is necessary to confirm this.
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Affiliation(s)
- Fenna Visser
- Department of Paediatrics, Juliana Children's Hospital, The Hague, The Netherlands.
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Abstract
UNLABELLED Premature infants are at significant risk of reduced bone mineral content (BMC) and subsequent osteopenia. There are currently no standard practices regarding screening, investigation or treatment of this condition. We present a case report and findings of a national survey of 36 level 2 and 3 neonatal units (72% response rate). The findings showed widely disparate practice regarding screening, prevention and treatment. We summarize the tests currently available for osteopenia and suggest guidelines for management of the at risk group. CONCLUSION Our survey confirms inconsistent practices regarding management of infants at risk of osteopenia of prematurity. Investigations and treatments available are summarized together with a guideline for management of this susceptible group of infants.
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Affiliation(s)
- C M Harrison
- Department of Neonatology, Leeds Teaching Hospitals Trust, Leeds, UK.
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22
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Cholevas V, Challa A, Lapatsanis PD, Andronikou S. Changes in red cell phosphate metabolism of preterm and fullterm infants with perinatal problems during their first month of life. Eur J Pediatr 2008; 167:211-8. [PMID: 17458560 DOI: 10.1007/s00431-007-0464-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
The effects of perinatal problems on red cell phosphate metabolism were studied in two groups of infants (preterms B and fullterms D) during the first month of life. All infants started milk feeding from day three after birth. The results were compared to those of healthy preterms (A) and fullterms (C), respectively. Comparisons were also made between the preterm and fullterm groups B and D. The preterms with perinatal problems (B) showed a significant delay in catching up with the plasma and red cell inorganic phosphate (Pi) levels of controls (A) throughout the first month of life (p < 0.05). In parallel, the erythrocyte 2,3 diphosphoglycerate (2,3-DPG) concentrations of the sick preterms lagged significantly behind those of controls (p < 0.001); but the ATP levels were comparable between the two groups. The fullterms behaved slightly differently. No significant differences in plasma Pi (Pl Pi) and red cell 2,3-DPG were seen between the sick and healthy neonates during the month of study, while red cell Pi (RBC Pi) and ATP were found to be lower in the sick ones (p < 0.05). The fullterms with perinatal problems (D) had significantly higher Pl Pi (p < 0.05) and RBC Pi (p < 0.01) than preterms with problems (B) from the first week of life and continued in a similar pattern until the end of the month. Red cell 2,3-DPG concentrations were found to be significantly correlated with Pl Pi and RBC Pi in both preterm groups (p < 0.01) and in the sick fullterms (p < 0.001) during the time of the study. In the healthy fullterms 2,3-DPG was found to correlate only with red cell Pi (p < 0.05). Perinatal problems seem to affect Pi metabolism to a different degree in preterm and fullterm neonates in the first month of life.
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Affiliation(s)
- V Cholevas
- Research Laboratory of Child Health Department, University of Ioannina, Medical School, P.O. Box 1186, Ioannina, 451 10, Greece.
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Giapros VI, Papaloukas AL, Andronikou SK. Urinary mineral excretion in preterm neonates during the first month of life. Neonatology 2007; 91:180-5. [PMID: 17377403 DOI: 10.1159/000097450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Accepted: 07/06/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Estimation of urinary parameters in preterm infants is a useful method for identifying metabolic derangements. OBJECTIVES A prospective, longitudinal, hospital-based study was designed to examine the variability and the associations in renal excretion of calcium (Ca), magnesium (Mg), phosphate (P) and sodium (Na) in formula-fed preterm infants during the first month of life. PATIENTS Thirty-four infants <32 weeks gestational age, clinically stable, not receiving nephrotoxic drugs. METHODS Measurements of serum and 8-hour urinary mineral and creatinine (Cr) concentrations were made in all infants during three periods (at 7-10, 14-17 and 21-26 days postnatally). The urinary parameters, FENa, FEP, UCa/UCr, UMg/UCr were calculated. 24- hour urinary excretion was estimated by extrapolation of the 8-hour values. RESULTS The 24-hour excretion values (median and range) (mmol/kg) during the three study periods were, respectively, for Ca: 0.027 (0.015-0.15), 0.030 (0.007-0.12), 0.031 (0.008-0.12), for P: 0.26 (0.07-0.83), 0.29 (0.06-0.67), 0.41 (0.22-0.70), for Mg: 0.025 (0.007-0.14), 0.025 (0.008-0.16), 0.027 (0.010-0.10) and for Na: 2.85 (0.8-15), 1.45 (0.3-17), 1.56 (0.6-4.3). Na excretion declined while the excretion of the other minerals remained stable. A positive correlation was observed between excretion of Ca, Mg and Na (Ca vs. Na r = 0.63, p < 0.0001; Ca vs. Mg r = 0.65, p < 0.0001; Na vs. Mg r = 0.38, p = 0.012) as well as between the renal parameters FENa, FEP, UCa/UCr, UMg/UCr and the respective 24-hour excretion values (r = 0.80, 0.86, 0.84, 0.81) CONCLUSIONS: Urinary excretion of Ca, P, and Mg in preterm formula-fed infants is stable during the first month of life while urinary Ca, Na and Mg are closely correlated during the same period.
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Affiliation(s)
- Vasileios I Giapros
- Neonatal Intensive Care Unit, Child Health Department, University of Ioannina, Ioannina, Greece.
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24
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Porter E, McKie A, Beattie TJ, McColl JH, Aladangady N, Watt A, White MP. Neonatal nephrocalcinosis: long term follow up. Arch Dis Child Fetal Neonatal Ed 2006; 91:F333-6. [PMID: 16705005 PMCID: PMC2672833 DOI: 10.1136/adc.2006.094755] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To assess the spontaneous resolution of neonatal nephrocalcinosis and its long term effects on renal function. METHODS Fourteen very low birthweight preterm babies with nephrocalcinosis were followed up at 5-7 years of age; 14 controls were matched for sex, gestation, and birth weight. Height, weight, blood pressure, and renal symptomatology were recorded, and a renal ultrasound scan was performed. Early morning urine osmolality and creatinine ratios of albumin, phosphate, calcium, oxalate and beta microglobulin were determined. Urea and electrolytes in the study group were determined, and glomerular filtration rate (GFR) and TmP/GFR (tubular reabsorption of phosphate per GFR) were calculated. Statistical analysis was performed on a group basis using the Mann-Whitney confidence interval. RESULTS Mean age was 6.9 years (range 5.81-7.68). An early morning urine osmolality >700 mOsm/kg was achieved in all cases. In two cases and four controls, the calcium/creatinine ratio was >0.7 mmol/mmol. In all cases, the GFR was normal (median 132.6 ml/min/1.73 m(2) (range 104.1-173.1)). Median TmP/GFR was 1.22 mmol/l (0.73-1.61), with two having levels below the normal range. These did not have persisting nephrocalcinosis. Nephrocalcinosis was found in three of the 12 cases scanned and one control. There were no significant differences in urine biochemistry. CONCLUSIONS Resolution of nephrocalcinosis occurred in 75% of cases. No evidence was found to suggest that nephrocalcinosis is associated with renal dysfunction in the long term. There was evidence of hypercalciuria in the cases and controls, suggesting that prematurity may be a risk factor.
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Affiliation(s)
- E Porter
- Southern General Hospital, Govan Road, Govan, Glasgow G51 4TF, Scotland, UK.
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Hooman N, Honarpisheh A. The effect of phototherapy on urinary calcium excretion in newborns. Pediatr Nephrol 2005; 20:1363-4. [PMID: 15973526 DOI: 10.1007/s00467-005-1951-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 03/04/2005] [Accepted: 03/10/2005] [Indexed: 11/25/2022]
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Current World Literature. Curr Opin Nephrol Hypertens 2005. [DOI: 10.1097/01.mnh.0000172731.05865.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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