Effect of Calcium Supplementation on Calcium and Phosphorus Balance and Renal Net Acid Excretion in Preterm Infants Fed a Standard Formula

Manz, Friedrich; Diekmann, L; Stock, G. J.

doi:10.1111/j.1651-2227.1989.tb17931.x

Cited by 16 publications

(13 citation statements)

References 16 publications

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“…In infants, the intestinal P absorption rate may well be above 90% [41]. In breast-fed infants the low P intake and the high intestinal absorption rate favor a low intestinal P concentration, as an essential condition for an acid pH of the feces inhibiting the growth of potentially pathogenic germs [102].…”

Section: Adaptation To a Special Kind Of Nurturing A Different Perspmentioning

confidence: 99%

Renal acid excretion in early infancy

Manz

Kalhoff

Remer

1997

Pediatric Nephrology

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In early infancy, complex disorders of acid base metabolism are more frequent than in any other age group, with a predisposition to metabolic acidosis due to an age-related low renal capacity for acid excretion and an unphysiologically high actual renal acid load in nutrition with common formulas. Recently in preterm and small-for-gestational-age infants, persistent maximum renal net acid excretion (NAE) with subnormal or normal blood acid base status, impaired weight gain, and adaptive hormonal reactions have been observed. Incipient late metabolic acidosis is one example of a mixed disorder of acid base metabolism with maximum renal NAE in early infancy. Alkali therapy is highly effective and can be realized both on an individual basis, using urine pH screening as a diagnostic criterium for maximum renal acid stimulation, or on a general preventive level using modified standard formula with a reduced actual renal NAE similar to that seen on alimentation with human milk. From an integrated point of view, the low glomerular filtration rate and renal capacity for acid excretion beyond the developmental age of more than 44 weeks, may well be interpreted as the result of a specific adaptation to breast feeding sparing energy, and thus an evolutionary advantage for the survival of mother and child.

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Section: Adaptation To a Special Kind Of Nurturing A Different Perspmentioning

confidence: 99%

Renal acid excretion in early infancy

Manz

Kalhoff

Remer

1997

Pediatric Nephrology

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“…Eine diese Relationen nicht berücksichtigende überschüssige Menge an Ca oder P kann vom Körper nicht genutzt werden und wird selbst bei bestehendem Mineralstoffmangel mit dem Urin ausgeschieden. Das optimale Verhältnis von Kalzium zu Phosphor in der Nahrung ist daher abhängig von der Höhe der Kalzium-und Phosphorzufuhr (16). Bei niedrigen Zufuhrmengen ist das optimale Verhältnis kleiner, bei hohen Zufuhrmengen größer (16).…”

Section: Introductionunclassified

“…Das optimale Verhältnis von Kalzium zu Phosphor in der Nahrung ist daher abhängig von der Höhe der Kalzium-und Phosphorzufuhr (16). Bei niedrigen Zufuhrmengen ist das optimale Verhältnis kleiner, bei hohen Zufuhrmengen größer (16).…”

Section: Introductionunclassified

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

et al. 1995

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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.

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“…Preterm infants fed with human milk receive less P and Ca than they need and show maximal tubular reabsorption of P, leading to non-detectable urinary concentrations of P and paradoxical hypercalciuria (9,10). Conversely, feeding a formula containing relatively low amounts of Ca leads to very low urinary Ca excretion and paradoxical hyperphosphaturia (9,11). Based on these data, the determination of Ca and P in spot urine samples was used for the individual adjustment of mineral intake (8).…”

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Calcium and phosphorus retention in extremely preterm infants supplemented individually

Trotter

Pohlandt

2002

Acta Paediatrica

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The aim of this study was to investigate the correlation between the retention of calcium (Ca) and phosphorus (P) and weight gain and intake of Ca and P when using the concept of individualized Ca and P supplementation in extremely low birthweight infants. Three‐day Ca and P balances were performed in 20 infants with a mean gestational age of 26.6 wk (between 24.1 and 28.7 wk) and a birthweight of 744 g (450–990), when the infant was able to tolerate at least 100 ml/kg/d of milk. The daily supplementation with Ca and P was individually adjusted to achieve a simultaneous excretion of ± 1.2 mmol/L Ca and ± 0.4 mmol/L P in the urine. In 16 of the 20 infants, the urinary concentrations of both Ca and P exceeded the lower limits. The retention of Ca (mean 3.8 mmol/kg/d, minimum 0.9; maximum 8.1; 57% of intake, 34–80) and P (2.4,1.1–4.2; 76%, 52–96) was significantly correlated with both the daily weight gain (16 g, 3–28; Ca r2= 0.22, p= 0.02; P r2= 0.21, p= 0.03) and the intake of Ca (6.5 mmol/kg/d, 2.4–10.2; r2=0.67, p > 0.001) and P (3.1,1.9–5.3; r2= 0.85, p > 0.0001). The molar ratio of the Ca and P intake was 2.2 (1.3–4.0). Conclusion: It was found that Ca and P retention was a function of growth and intake.

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Effect of Calcium Supplementation on Calcium and Phosphorus Balance and Renal Net Acid Excretion in Preterm Infants Fed a Standard Formula

Cited by 16 publications

References 16 publications

Renal acid excretion in early infancy

Renal acid excretion in early infancy

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

Calcium and phosphorus retention in extremely preterm infants supplemented individually

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