Parathyroid hormone – reference values and association with other bone metabolism markers in very low birth weight infants – pilot study

Matějek, Tomáš; Navrátilová, Martina; Žaloudková, Lenka; Maláková, Jana; Malý, Jan; Skálová, Sylva; Palička, Vladimír

doi:10.1080/14767058.2018.1450858

Cited by 18 publications

(17 citation statements)

References 43 publications

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“…When the serum 25(OH)D 3 level was above 20 ng/mL, then no linear correlation between 25(OH)D 3 and iPTH levels was noted, which was consistent with the results of the study by Martins et al among Brazilians [46]. Matejek et al reported a significant relationship between iPTH and 25(OH)D 3 from the second month of life in healthy preterm newborns and that decreasing the 25(OH)D 3 level was accompanied by increasing iPTH [47].…”

Section: Discussionsupporting

confidence: 88%

Infants’ Vitamin D Nutritional Status in the First Year of Life in Northern Taiwan

Chen

et al. 2020

Nutrients

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Vitamin D deficiency (VDD) and insufficiency (VDI) are common among exclusively breastfeeding infants. However, epidemiological evidence for the prevalence of VDD in infants during their first year of life in Taiwan has never been found. This trial determined the prevalence of VDD and VDI and the association between dietary vitamin D and vitamin D nutritional status in Northern Taiwan. A cross-sectional study was conducted on infants who returned to well-baby examinations from October 2012 to January 2014 in three hospitals: Shin Kong Wu Ho-Su Memorial Hospital, Taipei Medical University Hospital, and Shuang Ho Hospital. The specific vitamin D cut-off concentrations for VDD, VDI, and VDS are 25(OH)D3 levels ≤20, 21–29, and ≥30 (ng/mL). Overall, 481 infants’ parents completed a questionnaire comprising questions related to vitamin D nutritional status, including weekly time outdoors, breastfeeding status, anthropometric measurement, and assessment of dietary intake, including milk and complementary food. The results revealed that 197 (41%) and 212 (44%) of infants in their first year of life had VDI and VDD, respectively, by the Endocrine Society guidelines. Breastfed infants had a higher prevalence of VDI (86.1%) than did mixed-fed (51.9%) and formula-fed (38.5%) infants (p < 0.001). The prevalence of VDD was 55.4% in infants aged under six months but increased to 61.6% in infants aged over six months. Infants in the VDI and VDD groups had the same anthropometrics as those in the vitamin D sufficiency (VDS) group. Our results revealed that 25(OH)D3 had a negative correlation with the intact parathyroid hormone (iPTH) when the serum 25(OH)D3 level ≤20 ng/mL (r = −0.21, p = 0.001). The VDS group had a higher total vitamin D intake than did the VDI and VDD groups, which was mainly obtained from infant formula. Our data revealed that dietary vitamin D intake and birth season were major indicators in predicting VDD. Lower dietary vitamin D intake and born in winter and spring significantly increased the odds ratio (OR) for VDI by 1.15 (95% CI 1.09–1.20) and 2.02 (95% CI 1.10–3.70), respectively, and that for VDD by 1.23 (95% CI 1.16–1.31) and 2.37 (95% CI 1.35–4.17) without covariates adjustment, respectively. Furthermore, ORs for VDI and VDD significantly differed after adjustment for covariates. In conclusion, the prevalence of VDI and VDD were high in infants during the first year of life. Breastfeeding infants had difficulty in obtaining sufficient vitamin D from diet. In cases where the amount of sun exposure that is safe and sufficient to improve vitamin D status is unclear, breastfed infants aged below one year old are recommended to be supplemented with vitamin D.

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Section: Discussionsupporting

confidence: 88%

Infants’ Vitamin D Nutritional Status in the First Year of Life in Northern Taiwan

Chen

et al. 2020

Nutrients

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“…The reference range of plasma PTH in neonates is not well established. However, a recent study of 20 healthy preterm neonates (birth weight of 1000–1500 g, gestational age of 27–31 weeks) using third-generation chemiluminescence immunoassay demonstrated that the physiological range for PTH in neonates was close to the reference limits for adults (1–7 pmol/L; 9.4–66 pg/mL) 57. It is important to note that the trend in plasma PTH values is just as important as the absolute value, both for screening and monitoring.…”

Section: Introductionmentioning

confidence: 94%

Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences

Chinoy

Mughal²,

Padidela³

2019

Arch Dis Child Fetal Neonatal Ed

105

120

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Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP – primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.

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“…However, a cross-reactivity to epimer described in the VIDAS method is residual, and the supplements from drops and additional sources in our study contain only the D3 form. Unfortunately, while choosing secondary outcomes, we did not include parathormone levels, which might be a sensitive indicator of calcium-phosphate balance based on recently published research [17,[42][43][44]. However, we included TRP and urinary calcium-creatinine ratios, which are sensitive markers of sufficient bone metabolism.…”

Section: Discussionmentioning

confidence: 99%

Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial

Kołodziejczyk-Nowotarska,

Bokiniec,

Seliga-Siwecka

2021

Nutrients

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Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n = 55; approximately 800–1000 IU from combined sources) or monitored therapy (n = 54; with an option of dose modification). 25-hydroxyvitamin D [25(OH)D] concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52 ± 2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20−80 ng/mL) at 52 weeks of PCA (p = 0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.

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Parathyroid hormone – reference values and association with other bone metabolism markers in very low birth weight infants – pilot study

Abstract: The physiological range indicated by the measurements was close to the reference limits for adults (1-7 pmol/l; 9.4-66 pg/ml). PTH level above this range can be considered as hyperparathyroidism in preterm neonates.

Cited by 18 publications

References 43 publications

Infants’ Vitamin D Nutritional Status in the First Year of Life in Northern Taiwan

Infants’ Vitamin D Nutritional Status in the First Year of Life in Northern Taiwan

Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences

Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial

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