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Laborie S, Bonjour M, Bacchetta J, Mauras M, Butin M. Is 25OH Vitamin D Excess before 36 Weeks Corrected Age an Independent Risk Factor for Bronchopulmonary Dysplasia or Death? Nutrients 2023; 15:4423. [PMID: 37892498 PMCID: PMC10610390 DOI: 10.3390/nu15204423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Low 25-Hydroxyvitamin D (25(OH)D) in preterm infants is a risk factor for bronchopulmonary dysplasia (BPD), but increased supplementation failed to demonstrate a beneficial effect on BPD. In neonatal animal models, deficiency and excessive vitamin D exposure have been associated with increased mortality and histological alterations in the lung evocative of BPD. Our hypothesis is that 25(OH)D levels ≥ 120 nmol/L are also a risk factor for BPD or death. This retrospective single-center cohort study included only infants born at <31 weeks gestational age without major malformations with at least a determination of 25(OH)D at <36 weeks corrected age and no determination <50 nmol/L. Routine 25(OH)D determination was performed at 1 month and monthly thereafter. A total of 175 infants were included. Infants with BPD or who died had a significantly lower term and weight, but a similar frequency of 25(OH)D ≥120 nmol/L (50.5% vs. 43.9%, p = 0.53). The logistic regression identified weight (OR 0.997, 95% CI [0.995-0.998]) and term (OR 0.737, 95% CI [0.551-0.975]) as significantly associated with BPD or death; the occurrence of excessive 25(OH)D was not significantly associated (OR 1.029, 95% CI [0.503-2.093]). The present study did not demonstrate any significant association between excessive 25(OH)D after one month of age and BPD or death.
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Affiliation(s)
- Sophie Laborie
- Service de Réanimation Néonatale et Néonatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France;
| | - Maxime Bonjour
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France;
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69373 Lyon, France;
| | - Justine Bacchetta
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69373 Lyon, France;
- Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France
- INSERM 1033, Prévention des Maladies Osseuses, 69372 Lyon, France
| | - Mathilde Mauras
- Service Pédiatrie B, Hôpital Nord, CHU de Saint-Etienne, 42270 Saint Priest en Jarez, France;
| | - Marine Butin
- Service de Réanimation Néonatale et Néonatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France;
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69373 Lyon, France;
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, 69365 Lyon, France
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Embleton ND, Jennifer Moltu S, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, Gerasimidis K, van Goudoever JB, Haiden N, Iacobelli S, Johnson MJ, Meyer S, Mihatsch W, de Pipaon MS, Rigo J, Zachariassen G, Bronsky J, Indrio F, Köglmeier J, de Koning B, Norsa L, Verduci E, Domellöf M. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr 2023; 76:248-268. [PMID: 36705703 DOI: 10.1097/mpg.0000000000003642] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g. METHODS The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached. RESULTS In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier. CONCLUSIONS We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.
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Affiliation(s)
| | | | | | - Chris H P van den Akker
- the Department of Pediatrics - Neonatology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Virgilio Carnielli
- Polytechnic University of Marche and Division of Neonatology, Ospedali Riuniti, Ancona, Ancona, Italy
| | - Christoph Fusch
- the Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical School, Nuremberg, Germany
- the Division of Neonatology, Department of Pediatrics, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Silvia Iacobelli
- the Réanimation Néonatale et Pédiatrique, Néonatologie - CHU La Réunion, Saint-Pierre, France
| | - Mark J Johnson
- the Department of Neonatal Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- the National Institute for Health Research Biomedical Research Centre Southampton, University Hospital Southampton NHS Trust and University of Southampton, Southampton, UK
| | - Sascha Meyer
- the Department of General Paediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Walter Mihatsch
- the Department of Pediatrics, Ulm University, Ulm, Germany
- the Department of Health Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Miguel Saenz de Pipaon
- the Department of Pediatrics-Neonatology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - Jacques Rigo
- the Neonatal Unit, University of Liège, CHR Citadelle, Liège, Belgium
| | - Gitte Zachariassen
- H.C. Andersen Children's Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Flavia Indrio
- the Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jutta Köglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Barbara de Koning
- the Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorenzo Norsa
- the Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- the Department of Health Sciences, University of Milan, Milan, Italy
- the Department of Paediatrics, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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Wan M, Patel J, Rait G, Shroff R. Hypervitaminosis D and nephrocalcinosis: too much of a good thing? Pediatr Nephrol 2022; 37:2225-2229. [PMID: 35352192 DOI: 10.1007/s00467-022-05513-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mandy Wan
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,Institute of Pharmaceutical Science, King's College London, London, UK.
| | - Jignesh Patel
- Institute of Pharmaceutical Science, King's College London, London, UK.,Department of Haematological Medicine, King's College Hospital Foundation NHS Trust, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University of College London, London, UK
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
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Thoene M, Anderson-Berry A. Nutrition Support Practices for Infants Born <750 Grams or <25 Weeks Gestation: A Call for More Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10957. [PMID: 36078670 PMCID: PMC9517820 DOI: 10.3390/ijerph191710957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
With advances in medical care and efforts to care for continually smaller and younger preterm infants, the gestational age of viability has decreased, including as young as 21 or 22 weeks of gestation [...].
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Bacchetta J, Edouard T, Laverny G, Bernardor J, Bertholet-Thomas A, Castanet M, Garnier C, Gennero I, Harambat J, Lapillonne A, Molin A, Naud C, Salles JP, Laborie S, Tounian P, Linglart A. Vitamin D and calcium intakes in general pediatric populations: A French expert consensus paper. Arch Pediatr 2022; 29:312-325. [PMID: 35305879 DOI: 10.1016/j.arcped.2022.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/20/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in newborns, infants, children, and adolescents to prevent vitamin D deficiency and rickets in general populations. STUDY DESIGN We formulated clinical questions relating to the following categories: the Patient (or Population) to whom the recommendation will apply; the Intervention being considered; the Comparison (which may be "no action," placebo, or an alternative intervention); and the Outcomes affected by the intervention (PICO). These PICO elements were arranged into the questions to be addressed in the literature searches. Each PICO question then formed the basis for a statement. The population covered consisted of children aged between 0 and 18 years and premature babies hospitalized in neonatology. Two groups were assembled: a core working group and a voting panel from different scientific pediatric committees from the French Society of Pediatrics and national scientific societies. RESULTS We present here 35 clinical practice points (CPPs) for the use of native vitamin D therapy (ergocalciferol, vitamin D2 and cholecalciferol, vitamin D3) and calcium nutritional intakes in general pediatric populations. CONCLUSION This consensus document was developed to provide guidance to health care professionals on the use of nutritional vitamin D and dietary modalities to achieve the recommended calcium intakes in general pediatric populations. These CPPs will be revised periodically. Research recommendations to study key vitamin D outcome measures in children are also suggested.
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Affiliation(s)
- J Bacchetta
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France; INSERM U1033, LYOS, Prévention des Maladies Osseuses, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France.
| | - T Edouard
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Unité d'Endocrinologie, Génétique et Pathologies Osseuses, Filières Santé Maladies Rares OSCAR et BOND, Hôpital des Enfants, Toulouse, France
| | - G Laverny
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, CNRS UMR7104, INSERM U1258, Université de Strasbourg, Illkirch, France
| | - J Bernardor
- INSERM U1033, LYOS, Prévention des Maladies Osseuses, Lyon, France; Département de Pédiatrie, CHU de Nice, Nice, France
| | - A Bertholet-Thomas
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France; INSERM U1033, LYOS, Prévention des Maladies Osseuses, Lyon, France
| | - M Castanet
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Département de Pédiatrie, Filière Santé Maladies Rares OSCAR, CHU Rouen, Rouen, France
| | - C Garnier
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France
| | - I Gennero
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Unité d'Endocrinologie, Génétique et Pathologies Osseuses, Filières Santé Maladies Rares OSCAR et BOND, Hôpital des Enfants, Toulouse, France
| | - J Harambat
- Centre de Référence Maladies Rénales Rares, Unité de Néphrologie Pédiatrique, Hôpital Pellegrin-Enfants, Bordeaux, France; INSERM U1219, Bordeaux, France
| | - A Lapillonne
- Service de Pédiatrie et Réanimation Néonatales, EHU 7328 Université de Paris, Hôpital Necker- Enfants Malades, Paris, France; CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - A Molin
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Département de Génétique, Filière Santé Maladies Rares OSCAR, CHU Caen, Caen, France
| | - C Naud
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France
| | - J P Salles
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Unité d'Endocrinologie, Génétique et Pathologies Osseuses, Filières Santé Maladies Rares OSCAR et BOND, Hôpital des Enfants, Toulouse, France
| | - S Laborie
- Service de Réanimation Néonatale, Hôpital Femme Mère Enfant, Bron, France
| | - P Tounian
- Service de Nutrition et Gastroentérologie Pédiatriques, Hôpital Trousseau, Faculté de Médecine Sorbonne Université, Paris, France
| | - A Linglart
- AP-HP, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service d'Endocrinologie et diabète de l'enfant, Filières Santé Maladies Rares OSCAR, ERN endoRARE et BOND, Plateforme d'expertise des maladies rares Paris Saclay, Hôpital Bicêtre Paris-Saclay, Université Paris Saclay, INSERM U1185, Le Kremlin Bicêtre, France
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Laborie S, Denis A, Raverot V, Claris O, Bacchetta J, Butin M. A third of premature neonates displayed inadequate 25-hydroxyvitamin D levels before being discharged from a French neonatal intensive care unit. Acta Paediatr 2022; 111:104-106. [PMID: 34587322 DOI: 10.1111/apa.16126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/10/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Sophie Laborie
- Hospices Civils de LyonDepartement of Neonatal Intensive Care Hôpital Femme Mère Enfant Bron France
| | - Angélique Denis
- Université de Lyon Lyon France
- Université Claude Bernard Lyon 1 Villeurbanne France
- Service de Biostatistique et Bioinformatique Hospices Civils de LyonPôle Santé Publique Lyon France
- CNRSUMR 5558Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐Santé Villeurbanne France
| | - Véronique Raverot
- LBMMS, Biochemistry unit, Hormonology laboratory Groupement hospitalier Est Hospices Civils de Lyon Bron France
| | - Olivier Claris
- Hospices Civils de LyonDepartement of Neonatal Intensive Care Hôpital Femme Mère Enfant Bron France
- Université Claude Bernard Lyon 1 Lyon France
| | - Justine Bacchetta
- Faculté de Médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- Rhumatologie et Dermatologie Pédiatriques Centre de Référence des Maladies Rares du Calcium et du Phosphore Service de Néphrologie Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- INSERM 1033, Prévention des Maladies Osseuses Lyon France
| | - Marine Butin
- Hospices Civils de LyonDepartement of Neonatal Intensive Care Hôpital Femme Mère Enfant Bron France
- Centre International de Recherche en Infectiologie INSERM U1111CNRS UMR5308Ecole Normale Supérieure de LyonUniversité Claude Bernard Lyon 1 Lyon France
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Mathilde M, Butin M, Pascal R, Plaisant F, Laborie S, Bacchetta J. Local protocol helped to deliver vitamin D levels more accurately in preterm infants. Acta Paediatr 2022; 111:76-85. [PMID: 34460964 DOI: 10.1111/apa.16088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
AIM This study retrospectively evaluated the effectiveness and safety of a local hospital protocol of vitamin D supplementation for preterm infants, which was modified in 2016. METHODS We focussed on 99 preterm infants born before 31 weeks of gestation and admitted to the neonatal intensive care unit at the Femme Mere Enfant Hospital, Bron, France, from 1 January to 31 December 2018. Calcium and urinary calcium were measured, and 25-hydroxy vitamin D (25(OH)D) levels were monitored monthly and supplementation was adjusted, with 50-120 nmol/L considered normal. The results are presented as medians and interquartile ranges. RESULTS The infants were enrolled at a gestational age of 28.0 [26.9-29.1] weeks and birth weight of 960 [800-1160] g. When they were discharged at 37.3 [35.2-39.8] weeks, the overall 25(OH)D level was 98 [79-140] nmol/L: 4% had low levels, 63% had normal levels and 33% had high levels. Vitamin D supplementation was withdrawn for 60% more than one month before discharge. Rickets or fractures were not reported. CONCLUSION The modified protocol limited underdosing and significant overdosing, but moderate hypervitaminosis D was still frequent. Urgent studies are needed to determine the optimal supplementation and clinical impact of 25(OH)D on comorbidities in preterm infants.
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Affiliation(s)
- Mauras Mathilde
- Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
| | - Marine Butin
- Service de Néonatologie et Réanimation néonatale Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Centre International de Recherche en Infectiologie (CIRI) INSERM U1111CNRS UMR5308Ecole Normale Supérieure de Lyon Lyon France
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
| | - Roy Pascal
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- Laboratoire de Biométrie et Biologie Evolutive Hospices Civils de LyonCNRSUMR5558 Villeurbanne France
- Pôle Santé Publique Service de Biostatistique‐Bioinformatique Lyon France
| | - Franck Plaisant
- Service de Néonatologie et Réanimation néonatale Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Centre International de Recherche en Infectiologie (CIRI) INSERM U1111CNRS UMR5308Ecole Normale Supérieure de Lyon Lyon France
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
| | - Sophie Laborie
- Service de Néonatologie et Réanimation néonatale Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Centre International de Recherche en Infectiologie (CIRI) INSERM U1111CNRS UMR5308Ecole Normale Supérieure de Lyon Lyon France
| | - Justine Bacchetta
- Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Prévention des Maladies Osseuses INSERM 1033LYOS Lyon France
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Fayard J, Pradat P, Lorthois S, Bacchetta J, Picaud JC. Nephrocalcinosis in very low birth weight infants: incidence, associated factors, and natural course. Pediatr Nephrol 2022; 37:3093-3104. [PMID: 35348900 PMCID: PMC9587072 DOI: 10.1007/s00467-021-05417-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preterm kidney is exposed to various exogenous factors that may impact its function such as nephrotoxic drugs or nephrocalcinosis. We investigated prevalence and risk factors of nephrocalcinosis (NC) in recently born very low birth weight (VLBW) infants submitted to improved biological monitoring. METHODS Retrospective, case-control study in very preterm infants (< 32 + 6 weeks, ≤ 1500 g) admitted to a tertiary care unit during a 6-year period. Each case (ultrasound-diagnosed NC) was matched with two controls (no NC). Data were collected at days 15 and 30 of life and 35 weeks corrected age, with follow-up at 18 months and 3 years. RESULTS Of 525 eligible infants, overall prevalence of NC was 17.1% at 35 weeks corrected age. Prevalence was halved between 2012 (26.1%) and 2017 (11.8%). We included 265 infants, more than half being born before 28 weeks. Cases presented with more severe morbidity than controls, but reached statistical significance only in infants born < 28 weeks (88.2% vs. 68.3%, P = 0.01). Protein, energy, calcium, phosphorus, and vitamin D intakes were similar in the two groups and did not change significantly over the study period. Weight gain was similar in the two groups. Exposure to furosemide (OR [IC95%]: 1.26 [1.02; 1.57]) and postnatal growth (1.65 [1.04; 2.67]) were independent risk factors of NC. NC resolved 12-18 months after diagnosis in 61% of infants. CONCLUSION Prevalence of NC is significant but can be reduced. Furosemide should be cautiously prescribed in VLBW infants, and nutritional support must be well monitored to support postnatal growth and limit risk of nephrocalcinosis. TRIAL REGISTRATION ClinicalTrials.gov: NCT 04,860,583. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Jeanne Fayard
- Department of Neonatology, Hopital de la croix rousse, Hospices Civils de Lyon, 69004 Lyon, France ,Department of Neonatology, Hôpital de La Conception, Assistance Publique Des Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre Pradat
- Centre for Clinical Research, Hopital de la croix rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Sylvie Lorthois
- Department of Pediatric Radiology, Hôpital Femme Mère Enfant de Lyon, 69677 Hospices civils de Lyon, Bron, France
| | - Justine Bacchetta
- Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, Pediatric Nephrology Rheumatology and Dermatology Unit, Hôpital Femme Mère Enfant de Lyon, 69677 Hospices civils de Lyon, Bron, France ,INSERM 1033 Research Unit and Lyon, Est Medical School, Lyon 1 University, 69008 Lyon, France
| | - Jean-Charles Picaud
- Department of Neonatology, Hopital de la croix rousse, Hospices Civils de Lyon, 69004, Lyon, France. .,CarMen Laboratory, INSERM, INRA, Claude Bernard University Lyon 1, 69310, Pierre Bénite, France.
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[Nephrocalcinosis in children]. Nephrol Ther 2021; 17:58-66. [PMID: 33461896 DOI: 10.1016/j.nephro.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nephrocalcinosis is defined by calcium phosphate or calcium oxalate deposits in the kidney parenchyma, particularly in tubular epithelial cells and interstitial tissue. It should be differentiated from urolithiasis where calcium salts deposits are located in the kidney and urinary tract. The epidemiology of nephrocalcinosis in children is unknown but the condition is not so rare, with an increased incidence in preterm infants. Often detected as an incidental finding, nephrocalcinosis may be classified according to the radiological type: medullary, cortical or diffuse. Nephrocalcinosis in children can be caused by a variety of etiology. The most common causes concern medullary nephrocalcinosis and include hereditary tubular disorders, in particular distal renal tubular acidosis and Dent disease, metabolic disorders such as idiopathic hypercalciuria and hyperoxaluria, and iatrogenic causes such as vitamin D intoxication. In the newborn, the main cause is hypercalciuria of the premature baby, whose multifactorial origin is largely iatrogenic. Primary hyperoxaluria which can lead to early onset nephrocalcinosis and usually to chronic kidney disease should always be considered and further investigated. In order to provide a specific diagnosis, it is essential to take into account the family history, the clinical context and complete laboratory data. Early initiation of an appropriate etiological treatment is recommended and may prevent or delay the progression to chronic kidney disease in some cases.
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Kidney volume, kidney function, and ambulatory blood pressure in children born extremely preterm with and without nephrocalcinosis. Pediatr Nephrol 2019; 34:1765-1776. [PMID: 31338588 PMCID: PMC6775032 DOI: 10.1007/s00467-019-04293-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reduced kidney volume (KV) following prematurity is a proxy for reduced nephron number and is associated with the development of hypertension and end-stage renal disease in adults. We investigated whether extreme prematurity affects KV, function, and blood pressure in school-aged children and if nephrocalcinosis (NC) developed during the neonatal period had additional effects. METHODS We investigated 60 children at a mean age of 7.7 years: 20 born extremely preterm (EPT < 28 weeks gestational age with NC (NC+)), 20 born EPT without NC (NC-), and 19 born as full-term infants (control). We measured KV by ultrasound, collected blood and urine samples to evaluate renal function, and measured office and 24-h ambulatory blood pressure (ABPM). RESULTS Children born EPT had significantly smaller kidneys (EPT (NC+ NC-) vs control (estimated difference, 11.8 (CI - 21.51 to - 2.09 ml), p = 0.018) and lower but normal cystatin C-based glomerular filtration rate compared with control (estimated difference, - 10.11 (CI - 0.69 to - 19.5), p = 0.035). KV and function were not different between NC+ and NC- groups. Change in KV in relation to BSA (KV/BSA) from the neonatal period to school age showed significantly more EPT children with neonatal NC having a negative evolution of KV (p = 0.01). Blood pressure was normal and not different between the 3 groups. Fifty percent of EPT had a less than 10% day-to-night decline in ABPM. CONCLUSIONS Kidney growth and volume is affected by EPT birth with NC being a potential aggravating factor. Circadian blood pressure regulation seems abnormal in EPT-born children.
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