Minimal vitamin D and high calcium and phosphorus needs of preterm infants receiving parenteral nutrition.
Preterm infants (birth weight, 1,089 +/- 91 g; gestational age, 28.9 +/- 0.7 weeks; mean +/- SEM) with mixed medical and surgical indications for parenteral nutrition (PN) were observed to determine the adequacy of infusates with fixed, low-dose vitamin D (25 IU/dl) and two combinations of calcium and phosphorus. The duration of low-dose vitamin D PN ranged from 5 to 52 days, with a median of 27 days. Twelve infants were randomly assigned to low (standard) Ca and P doses (5 mM each; 20 mg/dl of Ca and 15.5 mg/dl of P) and 13 high Ca and P doses (15 mM each; 60 mg/dl of Ca and 46.5 mg/dl of P). The maximum daily vitamin D intake was similar for both groups (31 +/- 1.3 versus 33 +/- 1.2 IU/kg). Vitamin D status in either group, as indicated by serum 25-hydroxyvitamin D (25-OHD) concentrations, was normal. There was no significant difference in observed changes of serial measurements of serum calcium, magnesium, phosphorus, alkaline phosphatase, creatinine (Cr), 25-OHD, and vitamin D-binding protein concentrations or urinary Ca:Cr and Mg:Cr ratios. In the low-dose Ca and P group, the serum P level was consistently less than 4 mg/dl in five infants, serum 1,25-dihydroxyvitamin D concentrations were higher, and tubular reabsorption of phosphorus was consistently greater than 95% and significantly higher than in the high-dose Ca and P groups. Severe bone demineralization apparent on X-ray occurred in two infants, with a fractured distal left ulna in one of the two infants.(ABSTRACT TRUNCATED AT 250 WORDS)
Koo
W W
WW
Children's Hospital Medical Center, Cincinnati, Ohio.
Tsang
R C
RC
Succop
P
P
Krug-Wispe
S K
SK
Babcock
D
D
Oestreich
A E
AE
D002136:Calcium, Dietary / Q000008:administration & dosage* / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D008297:Male; D009751:Nutritional Requirements; D010289:Parenteral Nutrition, Total / Q000379:methods*; D010758:Phosphorus / Q000008:administration & dosage* / Q000097:blood / Q000652:urine; D014463:Ultrasonography; D014807:Vitamin D / Q000008:administration & dosage* / Q000097:blood / Q000652:urine
D002136:Calcium, Dietary; D014807:Vitamin D; D010758:Phosphorus