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Steven A great. Abrams, the brand new Committee For the Diet, Jatinder J. S. Bhatia, Steven A good. Abrams, Mark R. Corkins, Sarah D. de Ferranti, Neville H. Wonderful, for the D Requirements away from Enterally Given Preterm Kids. Pediatrics -0420
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Bone health is a critical concern in managing preterm infants. Key nutrients of importance are calcium, vitamin D, and phosphorus. Although human milk is critical for the health of preterm infants, it is low in these nutrients relative to the needs of the infants during growth. Strategies should be in place to fortify human milk for preterm infants with birth weight <1800 to 2000 g and to ensure adequate mineral intake during hospitalization and after hospital discharge. Biochemical monitoring of very low birth weight infants should be performed during their hospitalization. Vitamin D should be provided at 200 to 400 IU/day both during hospitalization and after discharge from the hospital. Infants with radiologic evidence of rickets should have efforts made to maximize calcium and phosphorus intake by using available commercial products and, if needed, direct supplementation with these minerals.
In 2011, new Institute from Treatments (IOM) put-out fat loss assistance to have calcium and you may supplement D consumption for everyone age groups. step one However, no consumption information were made especially for preterm kids, while they were felt yet another people and you can don’t fit during the guidance getting losing weight resource consumption produced by brand new IOM. Preterm babies features unique bones nutrient standards that can not be assumed are the same as those of full-identity newborn children. Past statements in the united states don’t have a lot of the recommendations so you’re able to full-label babies. 2 , step 3 Although not, Brand new Eu Area getting Pediatric Gastroenterology, Hepatology, and Nutrition has described enteral nutrients suggestions for preterm babies. cuatro , 5
Studies on in utero bones mineralization rates are restricted. Cadaver studies, starting with the brand new classic functions out-of Widdowson et al, 6 essentially support an out in utero accretion from calcium supplements inside the 3rd trimester out of 100 so you’re able to 130 milligrams/kilogram just about every day, peaking between thirty two and thirty-six weeks’ pregnancy. Phosphorus accretion is roughly 50 % of the fresh accretion out-of calcium supplements during pregnancy. Amazingly, new reevaluation of them study by using progressive body composition processes 7 offered philosophy like those people developed by Widdowson ainsi que al. six
In full-term infants, there is a strong correlation between maternal and infant cord blood 25-hydroxyvitamin D (25-OH-D) concentrations, although the cord blood concentration is less than the maternal concentration. 8 A substantial proportion of pregnant women, especially African American and Hispanic women in the United States and Europe, have 25-OH-D concentrations <20 ng/mL (50 nmol/L), 9 a value set for the basis of the Recommended Dietary Allowance. 1 However, in utero, skeletal mineralization is priin D status, making the clinical significance of 25-OH-D concentrations during pregnancy unclear. 10 , 11
Population-based studies of rickets among preterm infants are lacking; therefore, the frequency is not known or reliably estimated. Approximately 10% to 20% of hospitalized infants with birth weight <1000 g have radiographically defined rickets (metaphyseal changes) despite current nutritional practices. 12 This frequency is much lower than the 50% incidence in this population described before fortification of human milk and the use of preterm high mineral containing formulas were routine. 13 One challenge in identifying the prevalence of rickets is the confusion related to terminology. Rickets is defined by radiographic findings, not by any biochemical findings. Standard radiographic definitions of rickets are used. Poorly defined terms, such as osteopenia or biochemical rickets, are often used in the literature interchangeably with radiographically defined rickets. Rickets is not widely reported in preterm infants with birth weight >1500 g unless there are health issues severely limiting enteral nutrition.