Abstract
Preterm infants are at risk for impaired bone mineralization and growth in length later in life due to inadequate nutritional intake in the early postnatal period. To investigate whether increased nutritional supplementation of calcium, phosphate and protein in Very Low Birth Weight (VLBW) infants during the first 14days after birth was associated with improvement in length and bone development until 9-10years of age. Observational follow-up study of VLBW infants (birth weight<1500g or gestational age<32weeks) born in two consecutive years (eligible infants: 2004 n: 63 and 2005: n: 66). Cohort 2005 received higher intake of calcium, phosphate and protein with parenteral nutrition compared to Cohort 2004. Anthropometric data were collected during standard follow-up visits until five years, and additionally at 9-10years of age including measurements of bone mineral content, bone mineral density of the whole body and lumbar spine determined by dual-energy X-ray absorptiometry. Long-term growth trajectories of both cohorts were evaluated separately for participants born appropriate (AGA) and small for gestational age (SGA), stratified by gender. Multivariate linear regression was used to examine the effect of nutritional intake and clinical covariates on length and bone mineralization. Both cohorts achieved a catch-up in length to SDS within the normal range by 6months (length SDS: estimated mean (95% confidence interval (CI): 6months: Cohort 2004: -0.7 (-1.1, -0.3) Cohort 2005: -0.5 (-0.8, -0.2)). Bone mineral content and density were within the normal range and not different between the cohorts. SGA children achieved a catch-up in length at 5years with bone mineralization comparable to AGA children. Only for girls birth weight was significantly associated with length SDS (per gram: β 0.001; 95% CI (0.000, 0.003); p=0.03) There was no evidence of an association between early nutritional intake and bone mineralization. Children born as appropriate or small for gestational age preterm infants are able to catch up in length after the postnatal period, and achieve a normal length and bone mineralization at age nine-ten years. An improvement of calcium and phosphate intake during the first 14days after birth was not associated with improvement in length and bone development.
Highlights
Achieving growth and development comparable to healthy term born infants has been a challenge for the treatment of preterm born infants for many decades [1]
While early cohort studies demonstrated that Very Low Birth Weight (VLBW) infants experienced a significant growth retardation during the early postnatal period without catch-up to the initial birth percentile, more recent studies showed that improvement of early nutritional intake diminishes the cumulative nutritional deficit and thereby may prevent growth retardation [5,6,7]
While early studies showed that exclusive feeding of human milk in preterm infants leads to deficiencies of calcium and phosphate, it is nowadays generally recommended to fortify human milk with additional minerals, protein and vitamins [18,19,20]
Summary
Achieving growth and development comparable to healthy term born infants has been a challenge for the treatment of preterm born infants for many decades [1]. As the survival of Very Low Birth Weight (VLBW) infants has increased significantly during the last years, it is important to evaluate their long-term outcomes, especially since recommendations and policies with regard to nutritional intake have been changed to improve postnatal growth [2,3,4]. Objective: To investigate whether increased nutritional supplementation of calcium, phosphate and protein in Very Low Birth Weight (VLBW) infants during the first 14 days after birth was associated with improvement in length and bone development until 9–10 years of age. Conclusion: Children born as appropriate or small for gestational age preterm infants are able to catch up in length after the postnatal period, and achieve a normal length and bone mineralization at age nine–ten years. An improvement of calcium and phosphate intake during the first 14 days after birth was not associated with improvement in length and bone development
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