Abstract
Osteopenia in preterm infants (OP) remains an important challenge and is largely dependent on nutritional post-natal intake of factors influencing bone mineralization. We conducted a prospective case-control study to evaluate the importance of protein and vitamin D intake in OP among neonates with birth weight <1,250 g. Simultaneous serum parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca), phosphorus (P), vitamin D and protein levels were measured during the first six post-natal weeks. At 6 weeks of age, OP was evaluated using wrist radiographs. Comparisons were analyzed using multivariate linear regression, receiver operating characteristic curves, χ2 and Wilcoxon Rank Sum. Of the 26 premature infants enrolled, 13 developed radiographic OP. Daily protein intake (coef = −0.40, p = 0.001) and vitamin D concentrations (21 ± 5.7 ng/ml) were significantly lower in the OP group compared to non-OP subjects. ALP concentration exceeding 619 IU/L, sensitivity of 76.9% and specificity of 75%, was predictive of OP at 6 weeks post-natally. PTH levels were higher at 6 weeks in OP subjects (193 ± 102.5 pg/ml, p < 0.001) compared to non-OP subjects. The findings in this study support the role of vitamin D and protein intake in the development of OP in VLBW infants and inform future practice and research on best practices for OP management.
Highlights
In preterm infants, the risk of osteopenia of prematurity (OP), known as neonatal rickets or metabolic bone disease (MBD), is a common and important concern [1]
The etiology of OP is multifactorial with risk factors including low gestational age (GA) and birth weight (BW), prolonged use of parenteral nutrition (PN), as well as exposure to corticosteroid and caffeine [3, 11, 12]
There is still a need to better characterize the influence of vitamin D on OP risk in very low birth weight (VLBW) infants
Summary
The risk of osteopenia of prematurity (OP), known as neonatal rickets or metabolic bone disease (MBD), is a common and important concern [1]. The etiology of OP is multifactorial with risk factors including low gestational age (GA) and birth weight (BW), prolonged use of parenteral nutrition (PN), as well as exposure to corticosteroid and caffeine [3, 11, 12]. Inadequate vitamin D has been suggested as a cause of OP [16], several studies have reported normal levels of 25-hydroxy (25-OH) vitamin D in preterm infants with OP [17, 18]. This inconsistency may be attributable to the fact that there is no current consensus on the recommended dose of vitamin D for prevention of OP. There is still a need to better characterize the influence of vitamin D on OP risk in VLBW infants
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