Bone Mineralization In Infants Research Articles

Pulsed Vibro-Acoustic Analysis Technique for Monitoring Bone Health in Preterm Infants: A Pilot Study.

Despite advances in neonatal care, metabolic bone disease of prematurity (MBDP) remains a common problem in preterm infants. The development of non-invasive and affordable diagnostic approaches can be highly beneficial in the diagnosis and management of preterm infants at risk of MBDP. In this study, we present an ultrasound method called pulsed vibro-acoustic analysis to investigate the progression of bone mineralization in infants over time versus weight and postmenstrual age. The proposed pulsed vibro-acoustic analysis method is used to evaluate the vibrational characteristics of the bone. This method uses the acoustic radiation force of ultrasound to vibrate the bone. The generated acoustic waves are detected using a hydrophone placed on the skin over the tibia. The frequency of vibration and the speeds of received acoustic waves have information regarding the material property of the bone. We examined the feasibility of this method through an in vivo study consisting of 25 preterm and 10 full term infants. The pulsed vibro-acoustic data were acquired longitudinally in preterm infants with multiple visits and at a single visit in full term infants. Speed of sound and mean peak frequency of slow and fast sound waves recorded by hydrophone were used to analyze bone mineralization progress. Linear mixed model was used for statistical analysis in characterizing the mineralization progress in preterm infants compared to data from full term subjects. Significance changes in wave parameters (speed of sound and mean peak frequency) with respect to the postmenstrual age and weight in preterm infants were observed with p-values less than 0.05. Statistical significances in speed of sound measurement for both fast and slow waves were observed between preterm and full term infants, with p-values of <0.01 and 0.02, respectively. The results of this pilot study indicate the potential use of vibro-acoustic analysis for monitoring the progression of bone mineralization in preterm infants.

Korelacija između nivoa 25-hidroksivitamina D kod dojilja i mineralne gustine kostiju odojčadi i analiza faktora rizika

Background: Aim was to demonstrate the influencing factors of infant bone mineral density (BMD) and its correlation with serum 25-hydroxyvitamin D (25-(OH)D) in nursing mothers. Methods: 200 children aged 0 č 1 years were rolled into normal group (n=120) and abnormal group (n=80) regarding the results of ultrasound BMD examination. The sunshine duration of infants with different BMD and 25(OH)D, calcium and phosphorus levels of nursing mothers were analyzed, and univariate and multivariate analyses of BMD were implemented. Results: The results revealed that the sunshine duration and serum 25-(OH)D level of nursing mothers in abnormal group were inferior to those in normal group (P&lt;0.05). Additionally, a notable positive correlation existed between sunshine duration, serum 25-(OH)D level of nursing mothers and BMD (r = 0.911 and 0.503, P&lt;0.05). According to Logistic regression analysis, outdoor activity time 0 č 1 h/d, premature infants, and breastfeeding alone were independent risk factors (RFs) for abnormal BMD in infants, and vitamin D(VD) and calcium supplementation were independent protective factors (P&lt;0.05). Conclusions: VD and calcium intake, adequate sunshine duration, mixed feeding, and increasing serum 25-(OH)D can reduce the occurrence of abnormal BMD in infants.

Comparison of Infant Bone Mineral Content and Density After Infant Daily Oral Vit D 400 IU Supplementation Versus Nursing Mother Oral 6,400 IU Supplementation: A Randomized Controlled Lactation Study.

Background: Vitamin D (vitD) plays a major role in maintenance of bone mineral homeostasis. It is unknown if bone mineral content (BMC) and bone mineral density (BMD) differ between infants who receive direct vitD supplementation and those who receive vitD indirectly via their mother's breast milk, while she received a high dose of vitD. It is hypothesized that there would be no differences in BMC or BMD by treatment group. Design/Methods: Randomized, double-blind trial to compare BMD and BMC of infants who received direct vitD (400 IU vitD3/day) in addition to their mother receiving standard dosage (400 IU vitD3/day) versus infants whose mothers were their only source of vitD and were given high-dose supplementation (6,400 IU vitD3/day). Participants were exclusively breastfeeding mothers and their infant consuming only human milk. Infant BMC and BMD were measured by dual-energy X-ray absorptiometry (DXA) scans of the infant's total body using Hologic Discovery A Densitometer and analyzed using Hologic Infant software at 1, 4, and 7 months of age. Results: Infant BMC and BMD did not differ significantly at 1, 4, or 7 months of age between direct and indirect supplementation arms. The mean difference in BMC from 1 to 7 months was 1.624 and 1.464 g for the 400 and 6,400 IU groups, respectively, (p = 0.5); the mean difference in BMD over this same period was 0.042 and 0.032 g/cm2 for the 400 and 6,400 IU groups, respectively (p = 0.2). Although some differences among races were observed, this did not reflect changes in bone growth between the treatment arms. Conclusion: High-dose vitD supplementation of mothers during lactation provided an efficacious alternative to direct supplementation of infants, as evidenced by noninferior infant BMD and BMC. Clinical Trial Registration number: NCT00412074.

Impact of palm olein in infant formulas on stool consistency and frequency: a meta-analysis of randomized clinical trials

ABSTRACTBackground: Meta-analysis studies have documented that palm olein (PALM) predominant formulas reduce calcium and fat absorption, and bone mineralization in infants, but none have been documented for stool consistency and frequency.Objective: The study objective was to conduct a meta-analysis of published randomized clinical trials (RCTs) on the effect of PALM-based formulas on stool consistency and frequency in infants.Design: A literature search was conducted in BIOSIS Previews®, Embase®, Embase® Alert, MEDLINE® and Cochrane databases. PALM-based RCTs with available stool outcomes were selected and meta-analyzed. Mean rank stool consistency (MRSC, primary outcome) and stool frequency (secondary outcome) were compared between infants fed PALM-based and PALM-free formulas (NoPALM), using random effects model.Results: Nine out of identified16 studies were meta-analyzed. The mean MRSC (scale of 1 = watery to 5 = hard) in the NoPALM-fed infants was lower (softer stools) compared to the PALM-fed infants (mean difference ‒0.355, 95% Confidence Interval [CI] of ‒0.472 to ‒0.239, p < 0.001). Difference for stool frequency was not significant (p = 0.613).Conclusion: Meta-analysis of RCTs indicated that NoPALM-fed infants have significantly softer stools but similar stool frequencies versus PALM-fed infants, despite differences in study types and design. Future meta-analysis could benefit from including comparison with human milk-fed infants.

Effect of vitamin D replacement on maternal and neonatal outcomes: a randomised controlled trial in pregnant women with hypovitaminosis D. A protocol

IntroductionThe vitamin D recommended doses during pregnancy differ between societies. The WHO guidelines do not recommend routine prenatal supplementation, but they underscore the fact that women with the lowest levels...

Bone Mineral Content in Infants With Myelomeningocele, With and Without Treadmill Stepping Practice.

To study development of bone mineral content (BMC) in infants with myelomeningocele (MMC) who did or did not receive upright supported stepping practice (USSP) and in infants with typical development (TD). We tested 36 infants across the ages of 1 to 18 months. Dual-energy x-ray absorptiometry was used to collect raw BMC data for the whole body, legs, and arms, which were normalized using anthropometrics. Whole-body BMC generally increased with age; values for infants with MMC were slightly lower than those for infants with TD. Bone mineral content for legs and arms was lower for infants with MMC than for infants with TD. Between MMC groups, the group receiving USSP showed increases in BMC with age. Bone mineralization in infants with MMC begins to lag compared with infants with TD across infancy, and daily USSP can improve BMC as early as the first year of life.

Maternal plasma 25‐hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants

Maternal plasma 25‐hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants

Randomized, placebo-controlled, calcium supplementation study in pregnant Gambian women: effects on breast-milk calcium concentrations and infant birth weight, growth, and bone mineral accretion in the first year of life

Growth and bone mineral accretion in Gambian infants are poorer than those in Western populations. The calcium intake of Gambian women is low, typically 300-400 mg Ca/d, and they have low breast-milk calcium concentrations, which result in low calcium intakes for their breastfed infants. A low maternal calcium supply in pregnancy may limit fetal mineral accretion and breast-milk calcium concentrations and thereby affect infant growth and bone mineral accretion. We investigated the effects of calcium supplementation in Gambian women during pregnancy on breast-milk calcium concentrations and infant birth weight, growth, and bone mineral accretion. A randomized, double-blind, placebo-controlled supplementation study was conducted in 125 Gambian women who received 1500 mg Ca/d (as calcium carbonate) or placebo from 20 wk of gestation until delivery. Infant birth weight and gestational age were recorded. Breast milk was collected, and infant anthropometric and bone measurements were performed at 2, 13, and 52 wk after delivery. Infant bone mineral status was assessed by using single-photon absorptiometry of the radius and whole-body dual-energy X-ray absorptiometry. Compliance with the supplement was high. No significant differences were detected between the groups in breast-milk calcium concentration, infant birth weight, or growth or bone mineral status during the first year of life. A slower rate of increase in infant whole-body bone mineral content and bone area was found in the supplement group than in the placebo group (group x time interaction: P = 0.03 and 0.02, respectively). Calcium supplementation of pregnant Gambian women had no significant benefit for breast-milk calcium concentrations or infant birth weight, growth, or bone mineral status in the first year of life.

Physiologic predictors of lumbar spine bone mass in neonates.

Dual energy x-ray absorptiometry (DXA) of the lumbar spine (LS) was measured in 201 singleton infants with birth weights from 1152 to 3970 g and gestational ages from 27 to 42 wk. All infants were well and studied at a mean (+/-SD) of 2.1 (+/-1.6) days after birth. There were 75 Caucasian (46 males, 29 females) and 126 African American infants (58 males, 68 females). Scan acquisition of the first to fourth lumbar vertebrae was performed with a single beam whole body scanner (Hologic QDR 1000/W densitometer, Hologic Inc, Waltham, MA, U.S.A.) using the infant spine mode. Scan analysis was performed with software version 4.57Q and consistent region of interest. The SD of difference for duplicate LS scans is <1.4% at a mean bone mineral content (BMC) of 2.14 g. Results show that LS BMC, area, bone mineral density (BMD) increased by approximately 550%, 280% and 180%, respectively, between 27 and 42 wk gestational age. Body mass accounted for about 70% and 55% of the variance in BMC and BMD respectively. In contrast, the infant's length appears to be the best determinant of LS area and accounts for about 75% of the variance in LS area. Race, gender or season has little or no effect on LS bone mass. There was progressive increase in BMC and area from first to fourth lumbar vertebra but BMD was significantly higher only at the fourth lumbar vertebra. We conclude that DXA LS can be performed even in small preterm infants. Its excellent precision, low radiation exposure and rapid scan acquisition offers promise as a useful tool for widespread use in pediatrics. Our data may be used as a basis for further studies in physiologic and pathologic situations that may affect bone mineralization in infants.

Calcium, magnesium and phosphorus in the nutrition of the newborn.

Several factors have been suggested to contribute to inadequate bone mineralization in infants. Calcium and phosphorus intakes in preterm infants are below the intrauterine accretion rates. Calcium retention is influenced by the types of calcium salts used and by alterations in dietary phosphorus, fat and carbohydrates. Dietary intakes of vitamin D, and modifications in the protein base of infant formula, e.g., soy base vs cow milk base, may impact bone mineralization. The major hormonal mechanisms involved in the regulation of bone mineralization are parathyroid hormone, calcitonin and vitamin D. From recent animal studies, it has been suggested that parathyroid hormone related peptide (PTH-rp) may also play a role in perinatal calcium homeostasis.

Bone Mineral Metabolism in Full-Term Infants Fed Human Milk, Cow Milk—Based, and Soy-Based Formulas

To study the hypothesis that ingestion of a modified soy-based formula with an improved mineral suspension system may result in bone mineral content similar to that observed in infants fed human milk or cow milk-based formulas. Prospective, self-selected group of infants fed human milk randomized between the two formula-fed groups. University-based hospital nursery and follow-up. Fifty-six normal, healthy, full-term infants, free of major malformations or disorders, including 17 infants fed human milk, 19 infants fed a cow milk-based formula, and 20 infants fed a soy protein formula were followed up to 6 months' postnatal age. The soy-based formula studied was modified to improve the suspendability of the minerals. Infants were fed human milk or the study formula for the first 4 months, at which time beikost was permitted. Infants fed human milk received vitamin supplementation to provide 400 IU of vitamin D per day. Anthropometric variables, serum calcium, magnesium, phosphorus, alkaline phosphatase, and parathyroid hormone levels were measured at enrollment, and at 8, 16, and 24 to 26 weeks' postnatal age. Bone mineral content at the distal third radius site was measured with single photon absorptiometry at these times. Growth in the infants did not differ significantly among the groups. There was no significant difference in serum calcium, magnesium, alkaline phosphatase, or parathyroid hormone concentrations among the infants during the study. Serum phosphorus was significantly lower at 8 weeks in the group fed human milk than in that fed the cow milk-based formula. Bone mineral content at 16 and 24 to 26 weeks was higher in the group fed the soy-based formula than in that fed human milk, and bone width was also higher at 16 weeks in the infants fed the soy-based formula. Improving the suspendability of the mineral system in the soy formula results in bone mineralization in infants fed the soy-based formula similar to that measured in infants fed human milk and cow milk-based formula. We suggest that the suspendability of the minerals used is an important variable in the interpretation of the effect of feedings on the bone mineral status of infants.

Calcium Retention From Milk-Based Infant Formulas, Whey-Hydrolysate Formula, and Human Milk in Weanling Rhesus Monkeys

An adequate supply of calcium is important for normal bone mineralization in infants. Special infant formulas have been developed to treat infants with a high risk of developing allergy. Similar to other diets, it is important that these products are nutritionally adequate. We have measured calcium retention from a new formula based on whey hydrolysate and compared it with conventional formulas, using extrinsic labeling with calcium 47 and the weanling rhesus monkey as an animal model. Retention of calcium was similar for all formulas studied: 45% +/- 4% (mean +/- SEM) from whey-hydrolysate, 47% +/- 2% from whey-predominant, and 53% +/- 7% from casein-predominant formula. Calcium retention from human milk, 72% +/- 3%, was significantly higher than from formula. Using these retention values and the calcium concentrations of the diets, infant formula and human milk deliver approximately equal amounts of calcium to the infant.

Decreased bone mineral content in infants of diabetic mothers.

The present study was conducted to test the hypothesis that infants of diabetic mothers (IDMs) have decreased bone mineral content at birth, and whether or not decreased infant bone mineral content in IDMs correlates with poor control of diabetes during pregnancy, maternal bone mineral content, and the development of neonatal hypocalcemia. Forty-five pregnant diabetic women and their infants were enrolled in a prospective trial. In addition, 55 normal newborn infants of nondiabetic mothers were used as controls. Bone mineral content was measured before delivery in all diabetic pregnant patients and at birth in all infants by photon absorptiometry. Bone mineral content was significantly decreased in infants of diabetic mothers compared with control infants and correlated inversely with mean first trimester maternal capillary blood glucose; it did not correlate with cord serum 1,25-dihydroxyvitamin D concentrations. By stepwise multiple regression analysis, in infants of diabetic mothers, bone mineral content correlated inversely with mean first trimester capillary blood glucose and maternal bone mineral content, but did not correlate with maternal blood glycosylated hemoglobin, infant gestational age, infant birthweight or weight percentile, or development of neonatal hypocalcemia.

Pregnancy outcome in insulin-dependent diabetes: temporal relationships with metabolic control during specific pregnancy periods.

There are specific temporal relationships between metabolic control during different periods of pregnancy and outcome in insulin-dependent diabetic pregnancies. The rate of spontaneous abortions correlates with poor periconceptional glycemic control. Major malformations and decreased infant bone mineral content at birth correlate with poor first trimester glycemic control. Increased rates of preeclampsia and premature labor correlate with poor glycemic control in the second trimester. The development of macrosomia and that of neonatal hypoglycemia correlate with poor third trimester glycemic control. Perinatal asphyxia and neonatal hypoglycemia correlate with hyperglycemia in labor. We suggest that each stage of the pregnancy, if complicated by poor glycemic control, may lead to specific, temporally related complications. Glycemic control from the periconceptional period to the time of delivery appears important in order to minimize complications of the insulin-dependent diabetic pregnancy.

Bone mineral content measurement in small infants by single-photon absorptiometry: current methodologic issues.

Single-photon absorptiometry (SPA), developed in 1963 and adapted for infants by Steichen et al. in 1976, is an important tool to quantitate bone mineralization in infants. Studies of infants in which SPA was used include studies of fetal bone mineralization and postnatal bone mineralization in very low birth weight infants. The SPA technique has also been used as a research tool to investigate longitudinal bone mineralization and to study the effect of nutrition and disease processes such as rickets or osteopenia of prematurity. At present, it has little direct clinical application for diagnosing bone disease in single patients. The bones most often used to measure bone mineral content (BMC) are the radius, the ulna, and, less often, the humerus. The radius appears to be preferred as a suitable bone to measure BMC in infants. It is easily accessible; anatomic reference points are easily palpated and have a constant relationship to the radial mid-shaft site; soft tissue does not affect either palpation of anatomic reference points or BMC quantitation in vivo. The peripheral location of the radius minimizes body radiation exposure. Trabecular and cortical bone can be measured separately. Extensive background studies exist on radial BMC in small infants. Most important, the radius has a relatively long zone of constant BMC. Finally, SPA for BMC in the radius has a high degree of precision and accuracy.

Growth and bone mineralization of normal breast-fed infants and the effects of lactation on maternal bone mineral status

To determine if human milk provides for adequate growth and bone mineralization during the lst yr of life, 91 term infants were evaluated. Infants were divided into three groups human milk alone, human milk with supplemental vitamin D, and Similac. Lactating mothers who were receiving supplements of calcium and vitamin D were also studied to determine the effects of lactation on their bone mineral status. Blood was drawn from infants and mothers for measurements of serum calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D. Bone mineral content was measured by photon absorptiometry. Growth was similar between breast-fed and formula-fed infants. Regardless of type of feeding, male infants grew heavier and longer than corresponding female infants. Serum calcium and phosphate levels were similar among the three infant groups: only 25-hydroxyvitamin D levels at 4 months and serum alkaline phosphatase at 2 wk and 6 months of age were different among the three infant groups. Biochemical and vitamin D values were similar among the lactating mothers. There were no differences in infant bone mineral content among the three groups, but male infants had higher bone mineral content than female infants. There were no effects of the duration of lactation of maternal bone mineral content or vitamin D status.