Abstract
Preterm infants often have a reduced bone mineral content (BMC) with increased risk of metabolic bone disease. After birth it is difficult to supply calcium (Ca) and phosphorus (P) comparable to the high fetal accretion rate. It is not known whether high supplementation of minerals in the early postnatal period improves growth and bone mineralization. The aim of this study was to evaluate growth and bone mineralization at term corrected age (TCA) in very and extremely preterm infants who received different enteral Ca and P intakes during the first 10 days of life. Infants (n = 109) with birth weights below 1500 g were randomly assigned to one of three groups that differed in the nutritional protocols delivered until day 10: Group A, mother’s own milk (MOM) and donor milk (unfortified); Group B, MOM (unfortified) and preterm formula; Group C, MOM (start fortification >50 mL/day) and preterm formula. Due to the earlier commencement of fortification, Group C received higher intakes of calcium and phosphorus and protein (p < 0.001) until day 10. At TCA weight, length, BMC and bone mineral density (BMD), measured by dual-X-ray absorptiometry, were not different between the groups. Nutritional intake of P was positively associated with length (β; (95% confidence interval (CI): 0.20 (0.001; 0.393); p-value = 0.048), whereas Ca intake was negatively associated with BMC (−1.94 (−2.78; −1.09); p-value < 0.001). A small interaction between Ca and P intake was only found for BMD (0.003 (0.00002; 0.00006); p-value = 0.036). The volume of human milk per kg provided during the first 10 days was positively associated with BMC (β; (95% CI): 0.013 (0.002; 0.023); p < 0.017). Higher intakes of Ca and P during the first 10 days, as provided in this study, did not improve bone mineralization at term corrected age.
Highlights
Very and extremely preterm infants are known to have a reduced bone mineral content (BMC)with increased risk of development of metabolic bone disease (MBD) [1,2,3,4,5,6]
This study found no differences in weight, length, bone mineral content (BMC) and bone mineral density (BMD)
The regression analysis further showed that group assignment was not associated with the studied outcome measures; we found significantly positive associations between P intake and length, as well as the amount of human milk intake and BMC
Summary
Very and extremely preterm infants are known to have a reduced bone mineral content (BMC)with increased risk of development of metabolic bone disease (MBD) [1,2,3,4,5,6]. There are numerous reasons for impaired bone development in preterm infants, but an adequate supply of substrates of calcium (Ca) and phosphorus (P) is a prerequisite for normal bone mineral accretion, whereas vitamin. Dis essential for the adequate regulation of the mineral homeostasis and bone mineralization [5,7]. Infants born preterm miss this active foetal mineralization in the last trimester, and instead are reliant on supplementation of minerals, provided through parenteral and enteral sources [9,10]. Parenteral fluids have a limited solubility for high amounts of Ca and P, whereas human milk has low contents of calcium (Ca) and phosphorus (P) and formula feeding has been shown to have an impaired intestinal absorption of minerals [9,11,12]
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