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Diagnosis and management of early hypocalcaemia of prematurity

Posted:  Friday, August 12, 2016

The role of calcium and phosphorous in the treatment of osteopenia of prematurity

Calcium and phosphorus are important for the normal growth and mineralisation of bones in infants. A greater part of calcium and phosphorus is normally accumulated in the last trimester of pregnancy. Thus, infants born prematurely have low levels of calcium and phosphorus. A review article published in the journal NeoReviews discussed the impact of early hypocalcaemia (low blood calcium levels) on premature infants.

Treating hypocalcaemia with calcium via total parenteral nutrition has not exhibited short- or long-term benefits in premature infants. Attempts to supplement vitamin D in premature infants have not demonstrated any beneficial effects in the treatment of early hypocalcaemia of prematurity.

The absorption and retention of calcium in a premature infant are affected by factors such as gestational age, dietary fat, urinary losses of calcium, and vitamin D status. Mineral content from breast milk might not support normal bone mineralisation of premature infants. Specially designed high-mineral-containing formulas allow the premature infant to achieve an intake of calcium and phosphorus equal to that required for an intrauterine rate of accumulation. However, supplementing minerals via formulas may not lead to desirable calcium retention in premature infants.

Osteopenia of prematurity refers to hypomineralisation of the neonatal skeleton. It can be diagnosed after the disease has progressed to an advanced state. Chest, wrist, and knee radiographs and tenderness at fracture sites in the long bones indicate osteopenia of prematurity. It is very important to provide human milk fortifiers and special formulas with adequate calcium and phosphorus, for the management of osteopenia of prematurity.

Studies focusing on the long-term effects of osteopenia in very low-birth-weight infants are lacking. Very little information is available on the use of special transitional formulas in premature infants after hospital discharge. Recommendations for calcium and phosphorus supplementation after hospital discharge in these infants are also lacking.

News source - Greer FR. Calcium and Phosphorus and the Preterm Infant. NeoReviews. 2016 Apr 1; 17 (4):e195–202