Walter Mihatsch1,2, Ulrich Thome3, Miguel Saenz de Pipaon4. 1. Department of Pediatrics, Ulm University, 89075 Ulm, Germany. 2. Department of Health Management, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany. 3. Division of Neonatology, Children's Hospital, Department of Women's and Children's Health, University Hospital, 04103 Leipzig, Germany. 4. Department of Neonatology, Hospital Universitario La Paz, Department of Pediatrics, Universidad Autonoma de Madrid, 28046 Madrid, Spain.
Abstract
BACKGROUND: With current Ca and P recommendations for enteral nutrition, preterm infants, especially VLBW, fail to achieve a bone mineral content (BMC) equivalent to term infants. During the first 3 years, most notably in light at term equivalent age (<-2 Z score) VLBW infants' BMC does not catch up. In adults born preterm with VLBW or SGA, lower adult bone mass, lower peak bone mass, and higher frequency of osteopenia/osteoporosis have been found, implying an increased risk for future bone fractures. The aim of the present narrative review was to provide recommendation for enteral mineral intake for improving bone mineral accretion. METHODS: Current preterm infant mineral recommendations together with fetal and preterm infant physiology of mineral accretion were reviewed to provide recommendations for improving bone mineral accretion. RESULTS: Current Ca and P recommendations systematically underestimate the needs, especially for Ca. CONCLUSION: Higher enteral fortifier/formula mineral content or individual supplementation is required. Higher general mineral intake (especially Ca) will most likely improve bone mineralization in preterm infants and possibly the long-term bone health. However, the nephrocalcinosis risk may increase in infants with high Ca absorption. Therefore, individual additional enteral Ca and/or P supplementations are recommended to improve current fortifier/formula mineral intake.
BACKGROUND: With current Ca and P recommendations for enteral nutrition, preterm infants, especially VLBW, fail to achieve a bone mineral content (BMC) equivalent to term infants. During the first 3 years, most notably in light at term equivalent age (<-2 Z score) VLBW infants' BMC does not catch up. In adults born preterm with VLBW or SGA, lower adult bone mass, lower peak bone mass, and higher frequency of osteopenia/osteoporosis have been found, implying an increased risk for future bone fractures. The aim of the present narrative review was to provide recommendation for enteral mineral intake for improving bone mineral accretion. METHODS: Current preterm infant mineral recommendations together with fetal and preterm infant physiology of mineral accretion were reviewed to provide recommendations for improving bone mineral accretion. RESULTS: Current Ca and P recommendations systematically underestimate the needs, especially for Ca. CONCLUSION: Higher enteral fortifier/formula mineral content or individual supplementation is required. Higher general mineral intake (especially Ca) will most likely improve bone mineralization in preterm infants and possibly the long-term bone health. However, the nephrocalcinosis risk may increase in infants with high Ca absorption. Therefore, individual additional enteral Ca and/or P supplementations are recommended to improve current fortifier/formula mineral intake.
Entities:
Keywords:
bone mineral content; bone mineralization; calcium requirements; phosphorus requirements; preterm infant
Authors: Christian Buttazzoni; Björn Rosengren; Magnus Tveit; Lennart Landin; Jan-Åke Nilsson; Magnus Karlsson Journal: Calcif Tissue Int Date: 2015-10-15 Impact factor: 4.333
Authors: William F Carroll; Jorge Fabres; Tim R Nagy; Marcela Frazier; Claire Roane; Frank Pohlandt; Waldemar A Carlo; Ulrich H Thome Journal: J Pediatr Gastroenterol Nutr Date: 2011-09 Impact factor: 2.839
Authors: Walter A Mihatsch; Christian Braegger; Jiri Bronsky; Wei Cai; Cristina Campoy; Virgilio Carnielli; Dominique Darmaun; Tamas Desci; Magnus Domellöf; Nicholas Embleton; Mary Fewtrell; Natasa Fidler Mis; Axel Franz; Olivier Goulet; Corina Hartman; Hill Susan; Iva Hojsak; Silvia Iacobelli; Frank Jochum; Koen Joosten; Sanja Kolacek; Berthold Koletzko; Janusz Ksiazyk; Alexandre Lapillonne; Szimonetta Lohner; Dieter Mesotten; Krisztina Mihalyi; Francis Mimouni; Christian Mølgaard; Sissel J Moltu; Antonia Nomayo; Jean Charles Picaud; Christine Prell; John Puntis; Arieh Riskin; Miguel Saenz de Pipaon; Thibault Senterre; Ranaan Shamir; Venetia Simchowitz; Peter Szitanyi; Merit M Tabbers; Chris H B van den Akker; Johannes B van Goudoever; Anne van Kempen; Sascha Verbruggen; Jiang Wu; Weihui Yan Journal: Clin Nutr Date: 2018-06-07 Impact factor: 7.324
Authors: Shannon M Mitchell; Stefanie P Rogers; Penni D Hicks; Keli M Hawthorne; Bruce R Parker; Steven A Abrams Journal: BMC Pediatr Date: 2009-07-29 Impact factor: 2.125