Rickets in Premature Infants Receiving Parenteral Nutrition: A Case Report and Review of the Literature

Abstract

There is a multifactorial etiology for rickets in premature infants receiving total parenteral nutrition. As an example of this, we describe a premature infant fed almost exclusively parenterally for the first 8 months of life who developed biochemical and radiologic evidence of rickets despite receiving vitamin D, calcium, and phosphorus at presently recommended levels. From our experience and a review of previous literature, there appears to be considerable uncertainty regarding the intravenous requirements of calcium, phosphorus, and vitamin D, particularly in low-birth weight infants. Therefore, measurements of serum 25-hydroxyvitamin D levels, vitamin D, and mineral intakes, and calcium and phosphorus excretion might be clinically useful for monitoring premature infants receiving total parenteral nutrition. Further research delineating more precisely the vitamin D, calcium, and phosphorus requirements of such infants is also suggested.

Prevention of Postnatal Bone Demineralization in Very Low-Birth-Weight Infants by Individually Monitored Supplementation with Calcium and Phosphorus

“…pi to effect at least a low (1-2 mmol/L) simultaneous (7,8), Ca (7,9), Pi (10-1 3), Ca + Pi (14,19, as well as parented urinary excretion of both ions, as compared with infants nutrition (16)(17)(18)(19)(20), metabolic disease, physiotherapy, long-term ventilation and, finally, treatment with furosemide. both ions and accrete the bone &hilling and co-workers (2 1) described the pivotal biochemiat a lower rate ' The in bone miner?1 cal changes in breast milk-and formula-fed preterm infants and was sing1e P~~~~~~ densl-we have the findings many times (22): feeding with tome@ and lo weight gain during perids lo breast milk resulted in the phosp~openic type of rickets with wk.…”

Effect of Calcium/Phosphorus Ratio on Mineral Retention in Parenterally Fed Premature Infants

“…The use of TPN preparations containing inadequate amounts of calcium and pho sphorus is believed to be a major factor in the development of metabolic bone disease in VLBW infants (17). In the past , attempts to increase the concentrations of calcium and pho sphorus in the se solutions has resulted in mineral precipitation or in the use of solutions in which pho sphorus was delivered in exce ss of calcium (resulting in hyperphosphaturia) (4,18).…”