title: Results of extremely-low-birth-weight infants randomized to receive extra enteral calcium supply.
abstract: OBJECTIVE
  Bone mineral deficiency continues to occur in extremely-low-birth-weight (ELBW) infants despite formulas enriched in calcium (Ca) and phosphorus (P). This study tested whether extra enteral Ca supplementation increases bone mineral content (BMC) and prevents dolichocephalic head flattening and myopia in ELBW infants.
  
  
  METHODS
  Infants 401 to 1000 birth weight receiving enteral feeds were randomized to receive feeds supplemented with Ca-gluconate powder or pure standard feeds. The main outcome measures were the excretion of Ca and P by weekly spot urine measurements, the degree of dolichocephalic deformation (fronto-occipital diameter to biparietal diameter ratio, FOD/BPD) at 36 weeks postmenstrual age, and the BMC (by dual-energy x-ray absorptiometry) at discharge. Cycloplegic refraction was measured at 18 to 22 months corrected age.
  
  
  RESULTS
  Ninety-nine ELBW infants with a gestational age of 26 weeks (23-31) (median [minimum-maximum]) were randomized at a postnatal age of 12 days (5-23) weighing 790 g (440-1700). Urinary Ca excretion increased and P excretion decreased in the Ca-supplemented group. Total BMC was 89.9 ± 2.4 g (mean ± SE) in the supplemented group and 85.2 ± 2.6 g in the control group (P = 0.19). The FOD/BPD was 1.50 (1.13-1.69, mean ± SD [standard deviation]) and 1.47 (1.18-1.64) in the supplemented and control groups, and the refraction 0.98  ± 1.23 and 1.40 ± 1.33 dpt (P = 0.68), respectively in 64 ELBW infants (79% of survivors) at 2-year follow-up.
  
  
  CONCLUSIONS
  Extra enteral Ca supplementation did not change BMC, head shape, or refraction. The decreased P excretion may reflect P deficiency in infants receiving extra Ca, preventing improved bone mineral accretion.
authors.affiliation: Miami Children's Hospital, Miami, Florida, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Carroll
authors.forename: Jorge
authors.initials: J
authors.lastname: Fabres
authors.forename: Tim R
authors.initials: TR
authors.lastname: Nagy
authors.forename: Marcela
authors.initials: M
authors.lastname: Frazier
authors.forename: Claire
authors.initials: C
authors.lastname: Roane
authors.forename: Frank
authors.initials: F
authors.lastname: Pohlandt
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Ulrich H
authors.initials: UH
authors.lastname: Thome
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density / Q000187:drug effects*; D002118:Calcium / Q000172:deficiency; D002125:Calcium Gluconate / Q000008:administration & dosage; D002136:Calcium, Dietary / Q000008:administration & dosage*; D016022:Case-Control Studies; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight / Q000378:metabolism*; D007231:Infant, Newborn; D008297:Male; D010758:Phosphorus / Q000172:deficiency
chemical_list: D002136:Calcium, Dietary; D010758:Phosphorus; D002125:Calcium Gluconate; D002118:Calcium