Appropriate Phosphorus Intake by Parenteral Nutrition Prevents Metabolic Bone Disease of Prematurity in Extremely Low-Birth-Weight Infants.
BACKGROUND
Metabolic bone disease (MBD) is a common disorder in extremely low-birth-weight (ELBW) infants. However, no studies have investigated whether high-dose calcium (Ca) and phosphorus (P) supplementation by parenteral nutrition (PN) prevents MBD in ELBW infants. This study aimed to identify the effect of PN on MBD in ELBW infants.


METHODS
We retrospectively analyzed ELBW infants who were admitted between April 2011 and March 2017. ELBW infants were divided into the low-P group (n = 22) and the high-P group (n = 26) according to the dose of parenteral P supply. Biochemical and radiological markers of MBD and treatments were analyzed.


RESULTS
Mean daily parenteral intake of Ca and P in the first week was significantly higher in the high-P group than in the low-P group (both P ≤ .001). Serum alkaline phosphatase (ALP) levels were significantly higher in the low-P group than in the high-P group in the first month. ELBW infants in the low-P group received alfacalcidol much more frequently than those in the high-P group. There was a trend of a higher rate of x-ray changes in the low-P group than in the high-P group. No infants developed bone fractures.


CONCLUSION
Appropriate P intake by PN is required to ensure high Ca intake, reduce ALP levels in the first month, and prevent MBD from hyperparathyroidism and does not worsen x-ray findings in ELBW infants.
['Motokura|Kouji|K|0000-0003-1506-4667', 'Tomotaki|Seiichi|S|', 'Hanaoka|Shintaro|S|', 'Yamauchi|Takeru|T|', 'Tomotaki|Hiroko|H|', 'Iwanaga|Kougoro|K|', 'Niwa|Fusako|F|0000-0002-5295-6819', 'Takita|Junko|J|', 'Kawai|Masahiko|M|']
D001851:Bone Diseases, Metabolic D006801:Humans D007223:Infant D052577:Infant, Extremely Low Birth Weight D007231:Infant, Newborn D010288:Parenteral Nutrition D010758:Phosphorus D016226:Phosphorus, Dietary D012189:Retrospective Studies
phosphorus parenteral nutrition metabolic bone disease extremely low-birth-weight infant neonate osteopenia preterm