title: Serum vitamin D metabolites in very low birth weight infants with and without rickets and fractures.
abstract: Seventy-one very low birth weight (less than or equal to 1500 gm) infants were studied to determine the sequential changes in serum vitamin D metabolite concentrations between infants with and without radiographically documented rickets, fractures, or both (R/F). Usual intake of vitamin D included 20 IU/kg/day from parenteral nutrition or 400 IU/day supplementation with enteral feeding. Radiographs of both forearms and serum samples were obtained at 3, 6, 9, and 12 months. Twenty-two infants had R/F. At 3 months, significantly lower mean (+/- SEM) serum phosphorus levels (4.5 +/- 0.4 vs 6.1 +/- 0.2 mg/dl), higher 1,25-dihydroxyvitamin D (1,25-[OH]2D) concentrations (96 +/- 5 vs 77 +/- 4 pg/ml), and higher free 1,25-(OH)2D index (1,25-[OH]2D:vitamin D binding protein ratio; 5.2 +/- 0.3 x 10(5) vs 4.0 +/- 0.2 x 10(5] were found in the R/F group. These values returned to normal and were similar between groups on subsequent measurements. Serum calcium, magnesium, and 25-hydroxyvitamin D (25-OHD) concentrations were normal and similar between groups. In both groups, serum vitamin D binding concentrations increased initially but remained stable and normal beyond 6 months. We conclude that in very low birth weight infants with R/F, the vitamin D status (as indicated by serum 25-OHD concentrations) is normal, and that lowered serum phosphorus levels, higher serum 1,25-(OH)2D levels, and a higher free 1,25-(OH)2D index support the thesis that mineral deficiency (especially of phosphorus) may be important in the pathogenesis of R/F in small preterm infants.
authors.affiliation: Department of Pediatrics, University of Cincinnati, Children's Hospital Research Foundation, Ohio.
authors.forename: W W
authors.initials: WW
authors.lastname: Koo
authors.forename: R
authors.initials: R
authors.lastname: Sherman
authors.forename: P
authors.initials: P
authors.lastname: Succop
authors.forename: M
authors.initials: M
authors.lastname: Ho
authors.forename: D
authors.initials: D
authors.lastname: Buckley
authors.forename: R C
authors.initials: RC
authors.lastname: Tsang
mesh_terms: D002112:Calcifediol / Q000097:blood*; D002117:Calcitriol / Q000097:blood*; D004750:Enteral Nutrition; D050723:Fractures, Bone / Q000097:blood* / Q000150:complications; D006801:Humans; D007230:Infant, Low Birth Weight / Q000097:blood*; D007231:Infant, Newborn; D010288:Parenteral Nutrition; D011446:Prospective Studies; D012279:Rickets / Q000097:blood* / Q000150:complications; D014807:Vitamin D / Q000008:administration & dosage; D014809:Vitamin D-Binding Protein / Q000097:blood*
chemical_list: D014809:Vitamin D-Binding Protein; D014807:Vitamin D; D002117:Calcitriol; D002112:Calcifediol