Continuous Nasogastric Phosphorus Infusion in Hypophosphatemic Rickets of Prematurity

Koo, Winston; Antony, Gabriel; Stevens, L. H.

doi:10.1001/archpedi.1984.02140400054013

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Infants in our study had higher urine Ca:Cr ratios, compared with reported values for normally fed infants and children (32,33), but these are comparable to other reports of infants receiving PN (34). In infants, hypercalciuria, with simultaneous increase in TRP, has been associated with P depletion (35), and this may partly explain the mechanism of hypercalciuria in infants who received the low Ca, P infusate. Increased P administration in PN has been shown to decrease calciuria in preterm infants (34), and to increase Ca retention in infants and children (36).…”

Section: Discussionsupporting

confidence: 84%

“…Urinary P excretion in adults and children during PN also may be related to the P load (26,36,40). Furthermore, urinary P excretion may be minimal when P requirements are high (24,35,36). In this study, high TRP in infants who received the low Ca, P infusate presumably reflects an extreme physiologic adaptation to conserve P during low P intake.…”

Section: Discussionmentioning

confidence: 65%

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Parenteral Nutrition for Infants

Koo,

Tsang,

Steichen

et al. 1987

J. pediatr. gastroenterol. nutr.

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SummaryCalcium (Ca) and phosphorus (P) homeostasis were determined in 18 infants (birth weight, 2,810 ± 135 g; gestational age, 37.4 ± 0.5 weeks; mean ± SEM) who received high or low Ca and P content (Ca, P) parenteral nutrition (PN) with a fixed, low dose of vitamin D (25 IU/dl). Nine infants were randomized into low (standard) Ca, P (20 mg Ca and 15.5 mg P/dl) and nine into high Ca, P (60–80 mg Ca and 46.5–62 mg P/dl) PN, and then were studied for up to 6 weeks. The high Ca, P group had stable serum 1,25 dihydroxyvitamin D [1,25(OH)2D], which consistently remained within the normal range (<116 pg/ml). Tubular reabsorption of phosphorus (TRP) also was stable and remained consistently <90%. The low Ca, P group had elevated and higher 1,25(OH)2D (p = 0.03) than the high Ca, P group. The mean serum 1,25(OH)2D concentration rose from 32 to 112, 115, and 133 pg/ml over a period of 6 weeks. TRP also was higher (p = 0.02) and remained consistently >90%. There were no significant differences between groups in serum parathyroid hormone, calcitonin, Ca, Mg, P, alkaline phosphatase, vitamin D binding protein, and 25 hydroxyvitamin D concentrations; urine Ca/creatinine and Mg/creatinine ratios, and fractional excretion of sodium (Na). Thus, a “high” Ca (60 mg/dl) and P (46.5 mg/dl) content in PN solutions can result in stable serum 1,25(OH)2D and TRP, presumably reflecting minimal stress to Ca and P homeostatic mechanisms without further increase in urinary Ca excretion.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 65%

Parenteral Nutrition for Infants

Koo,

Tsang,

Steichen

et al. 1987

J. pediatr. gastroenterol. nutr.

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“…Lower phosphate levels may reflect their relative nutritional deficiency in utero. The normal calcium values in the SGA infants may thus indicate substrate shortage for bone mineralization, phosphate being the limiting mineral (3,24).…”

Section: Discussionmentioning

confidence: 99%

Plasma Ionized Calcium, Phosphate and Magnesium in Preterm and Small for Gestational Age Infants

Nelson¹,

Finnström²,

Larsson

1989

Acta Paediatrica

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Blood concentrations of ionized calcium, phosphate and magnesium were determined on days 1, 3 and 5 in 32 preterm infants, appropriate for gestational age, and 25 small for gestational age infants. The results were compared with those of a reference group of 31 fullterm newborns. Preterm infants had lower mean ionized calcium levels than the reference population. Ionized calcium levels were positively correlated with gestational age and postnatal age. The sickest infants had the lowest calcium levels. Intrauterine growth retardation did not seem to influence the calcium levels. Small for gestational age infants had lower phosphate values than the reference group and the values correlated with the degree of growth retardation the first day. Magnesium concentrations increased with time and did not differ significantly between the study groups and the reference group. Magnesium values did not correlate with calcium or phosphate values.

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“…The frequency of rickets is greater in the very low birth weight infant (VLBWI) with a complicated neonatal course or those receiving long-term parenteral nutrition (3,4), human milk (5,6), or a soy isolate formula (7). Vitamin D deficiency may cause rickets, but calcium and phosphorus deficiencies are considered major contributing factors (4)(5)(6)(7)(8)(9)(10)(11). Thus, formulas that contain increased amounts of calcium (144 mg/dl) and phosphorus (72 mg/dl) have been designed to meet the particular needs of the rapidly growing VLBWI.…”

Section: Departments Of Pediatrics and Obstetrics And Gynecology Univ...mentioning

confidence: 99%

Rickets in a Very Low Birth Weight Infant

Cooke

1989

J. pediatr. gastroenterol. nutr.

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A report on a case of rickets in a very low birth weight infant (VLBWI) is presented. The infant had no high‐risk factors for rickets and was fed a specialized preterm formula with vitamin D supplementation (200 IU daily) by 10 days of age. Feeds were advanced so that an enteral intake of 120 cal/kg/day was achieved by the 20th day of life. Mean calcium, phosphorus, and vitamin D intakes between the 20th and 61st days of life were 185 mg/kg/day, 93 mg/kg/day, and 367 IU/day, respectively. On the 62nd day of life, a diagnosis of rickets was made. and a nutrient balance study was performed. Urinary calcium excretion was low (1.3 mg/kg/day), suggesting calcium deficiency. However/retention of calcium (127 mg/kg/day) and phosphorus (76 mg/kg/day) was occurring at intrauterine rates. Thus, while calcium absorption was adequate at 10 weeks of age, the same was not true earlier in life. We suggest that there is a limiting role of calcium absorption on bone mineralization during early life in the VLBWI.

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Continuous Nasogastric Phosphorus Infusion in Hypophosphatemic Rickets of Prematurity

Cited by 6 publications

References 15 publications

Parenteral Nutrition for Infants

Parenteral Nutrition for Infants

Plasma Ionized Calcium, Phosphate and Magnesium in Preterm and Small for Gestational Age Infants

Rickets in a Very Low Birth Weight Infant

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