Abstract
Background: With current Ca and P recommendations for enteral nutrition, preterm infants, especially VLBW, fail to achieve a bone mineral content (BMC) equivalent to term infants. During the first 3 years, most notably in light at term equivalent age (<−2 Z score) VLBW infants’ BMC does not catch up. In adults born preterm with VLBW or SGA, lower adult bone mass, lower peak bone mass, and higher frequency of osteopenia/osteoporosis have been found, implying an increased risk for future bone fractures. The aim of the present narrative review was to provide recommendation for enteral mineral intake for improving bone mineral accretion. Methods: Current preterm infant mineral recommendations together with fetal and preterm infant physiology of mineral accretion were reviewed to provide recommendations for improving bone mineral accretion. Results: Current Ca and P recommendations systematically underestimate the needs, especially for Ca. Conclusion: Higher enteral fortifier/formula mineral content or individual supplementation is required. Higher general mineral intake (especially Ca) will most likely improve bone mineralization in preterm infants and possibly the long-term bone health. However, the nephrocalcinosis risk may increase in infants with high Ca absorption. Therefore, individual additional enteral Ca and/or P supplementations are recommended to improve current fortifier/formula mineral intake.
Highlights
Appropriate mineral and vitamin D intakes are essential for adequate bone health.The optimum target for mineral accretion in preterm infants on enteral nutrition is unknown
Incidences of Bone mineral deficiency of prematurity (BMDP) of about 40% [9] in very low birthweight (VLBW) infants and 50% in extremely low birthweight (ELBW) infants [21] have been reported in the past
One study reports a clear trend towards a reduced BMD in former preterm infants, but no significant difference was found [33] whereas others report significantly reduced bone mineral density in former preterm infants when compared to term infants [34,35]
Summary
Appropriate mineral and vitamin D intakes are essential for adequate bone health. The optimum target for mineral accretion in preterm infants on enteral nutrition is unknown. The widely accepted physiologically relevant outcome is an accretion of bone mass that is proportional to the linear growth weight gain as achieved by the fetus in utero and subsequently the term born infant over the first year [1,2,3,4,5]
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