Abstract
High Ca, P fortified ‘premie’ formulas (FM) have been recommended as supplements to preterm infants fed own mother's milk (OMM) to prevent rickets. FM (20kcal/dl) when added to OMM in 1:1 ratio by volume and given 150ml/kg/d can deliver maximum Ca 78-113mg, P 44-59mg and vit D 42-79IU/kg/d. Two white females, birth wt 410g (P1), 660g (P2), gestation 23, 30 wks resp given FM alone, or, FM added to OMM or standard (20kcal/oz) formula (SM) who developed severe bone demineralization, rickets and fractures on x-ray at 15 and 13wks resp. Nutrition intake prior to diagnosis was: *Parenteral solution Ca 2hg, P 15mg/dl, vit D2 20 IU/kg/d. ** Daily Ca, P, vit D intake from FM alone, or, FM+OMM or SM. Additional 100-400 IU vit D2/d commenced at 63 and 14d resp. FM were shaken prior to each bolus gavage feed. P1 received 24 doses furosemide (1-2mg/kg) and 43d of phenobarbital (5mg/kg/d). P2 received 4 doses of furosemide (1-2mg/kg). At diagnosis, serum Ca and Mg were normal, P were 3.6 and 4.8mg/dl, and 25 hydroxyvitamin D (250HD) normal (61 and 38ng/ml). Rickets and fractures healed while Pl continued on FM and same drug therapy and P2 was fed OMM alone. We conclude 1) supplementation of OMM or SM with Ca, P fortified milk (1:1 vol/ vol) may not be sufficient to prevent rickets and fracture in extremely small infants (BW<800g); 2) 400 IU vit D2/d is sufficient to maintain normal serum 250HD. 3) Rickets may resolve “spontaneously” with age.
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