Anreicherung einer Frühgeborenenmilchnahrung mit Kalzium und Phosphor zur Verbesserung der Mineralstoffversorgung Früh- und Mangelgeborener*

Abstract

A standard preterm formula was supplemented with calcium (Ca) and phosphorus (P) (F-CaP: Ca 87 mg/dl, P 43 mg/dl) and compared to the non-supplemented form (F: Ca 62 mg/dl, P 36 mg/dl). VLBW and small-for-gestational-age infants (n = 79) were included in the study which was performed to look for adverse effects and to decide about a reasonable start and duration of supplementation. In preterm infants with a birth weight lower than 1500 g and a body weight of more than 2000 g, the additional supplementation with Ca and P lead to a significant higher Ca- and P-retention without further load for the kidney. In addition, preterm infants with a body weight lower than 1500 g also had a better retention of Ca and P. Both, F-CaP and F lead to a high urinary excretion of phosphorus, a high renal net acid excretion and a relatively high activity of serum alkaline phosphatase. Anthropometric measurements did not reveal any evidence for an impaired caloric absorption due to an increased fecal fat excretion. Hypercalcemia or hyperphosphatermia was not seen. Hypercalciuria occurred in less than 5% of the samples studied. The results of this study indicate that a continuation of the supplementation with Ca and P is justified in VLBW infants with a body weight of more than 2000 g. There was no evidence for adverse effects of Ca and P supplementation in VLBW infants with a body weight lower than 1500 g, who might therefore also benefit from supplementation. Further studies are necessary to investigate unsatisfactory metabolic conditions of these children e.g. the high renal load.

Urinary excretion of aldosterone, arginine vasopressin and Cortisol in premature infants with maximum renal acid stimulation

“…Table 1 shows the clinical and biochemical data on day 1 before treatment in premature infants with MRAS, a subgroup of 19 patients (part of the study group of 77 patients with 80 episodes of MRAS) exclusively fed the preterm formula F as well as 19 pair-matched controls Table 1. Clinical (mean fSD) and biochemical (median (range)) data on day 1 before treatment in 77 premature infants with spontaneous development of 80 episodes of maximum renal acid stimulation, a subgroup of 19 patients as well as 19 pair-matched controls with normal renal acid stimulation both fed the same preterm formula F. with normal renal acid stimulation, also fed the preterm formula F, from a different study (4). Urinary excretion rates of Aldo, AVP and cortisol in the subgroup fitted well to the data of the whole study group.…”

Modified Cow's Milk Formula with Reduced Renal Acid Load Preventing Incipient Late Metabolic Acidosis in Premature Infants

“…Eleven patients (subgroup B 1 ) fed the modified formula B and 23 patients of subgroup A 1 fed the standard formula A were not different in group characteristics (Table 2). Nine patients of subgroup A 2 with formula A showed significant differences in postnatal age and actual body weight (Table 2), as the balance study in this subgroup was done at an actual body weight >2 kg according to a different protocol (8). Intake volume tended to be higher in patients of subgroup A 2 , as some of these older patients were fed ad libitum.…”

“…The data of the patients fed formula B are compared in Table 1 with earlier results (7,8) of urine pH screening in a similar screening cohort of 282 premature infants (between June 1990 and May 1992) receiving either mother's milk (with or without a human milk fortification; n = 28) or an earlier batch (formula A) of the same standard formula with or without supplement of the same amount of Ca and P. Furthermore, form comparison of urinary data, 23 premature infants (subgroup A 1 ) (7) and for comparison of balance data, nine premature infants (subgroup A 2 ) (8), both fed formula A, are presented. There was no change in general guidelines of clinical care of prematures with body weight <2.0 kg between 1990‐1992 and 1993‐1994.…”

Renal Excretion of Calcium and Phosphorus in Premature Infants With Incipient Late Metabolic Acidosis

“…Urinary ionograms were compared between 10 premature infants with a body weight of 1.0 kg to 1.9 kg on day 1 with ILMA (group IO) and 10 pair-matched (gestational age, actual body weight) premature infants without ILMA (group NO) participating in another study (4), both receiving full oral ali-mentation with the standard cow milk formula F. Moreover, in a prospective randomized study, alkali therapy was compared with sodium chloride (NaCl, equivalent molar load) supplement for 7 days each in 37 premature infants (body weight, 1.5-1.9 kg) with spontaneous development of ILMA while receiving formula F or receiving oral/parenteral nutrition (but without parenteral intake of calcium or phosphorus) (5). Patients with severe clinical disorders, such as cardiac defects, or those receiving medication that could influence acid-base homeostasis were excluded.…”