[Efficacy and side effects of differential calcium and phosphate administration in prevention of osteopenia in premature infants].
The prevention of osteopenia and frequency of renal and intestinal side effects of mineral supplementation was studied in 24 preterm infants with birth weight under 1,500 g, prospectively (gestational age 26-34 weeks). Calcium intake varied from 2.5 vs. 3.75 vs. 5 mmol/kg/day, phosphate was offered in dose of 2.5 mmol/kg/day. At the expected birth date 40% of infants with low calcium dose showed an activity of serum alkaline phosphatase greater than five times the maximum adult normal value which is defined as a reliable marker; for osteopenia no infant with medium or high calcium intake reached this critical value (p = 0.03). Medium and high calcium doses resulted in an increased risk for hypercalcuria (25 vs. 50%) (p = 0.03). Half of these infants developed typical signs of nephrocalcinosis on ultrasound examination. No significant difference of fecal fat content was observed with increased calcium intake; but more episodes of abdominal distension occurred during the first days of high calcium supplementation (p = 0.03). We conclude, that a calcium intake of 3.75 mmol/kg/day in combination with phosphate 2.5 mmol/kg/day is sufficient for adequate bone mineralization on a low level of side effects. Calcium excretion in urine has to be observed for early diagnosis of nephrocalcinosis.
Kreuder
J
J
Zentrum für Kinderheilkunde, Justus-Liebig-Universität, Giessen.
Otten
A
A
Reiter
H L
HL
Klingmüller
V
V
Wolf
H
H
D000469:Alkaline Phosphatase / Q000097:blood; D001851:Bone Diseases, Metabolic / Q000201:enzymology / Q000517:prevention & control*; D002118:Calcium / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000201:enzymology / Q000517:prevention & control*; D009397:Nephrocalcinosis / Q000000981:diagnostic imaging; D010289:Parenteral Nutrition, Total; D010710:Phosphates / Q000008:administration & dosage* / Q000009:adverse effects; D014463:Ultrasonography
D010710:Phosphates; D000469:Alkaline Phosphatase; D002118:Calcium
Effizienz und Nebenwirkungen differenter Kalzium- und Phosphatzufuhr in der Prävention der Frühgeborenenosteopenie.