Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Italian Journal of Pediatrics
Published in: Italian Journal of Pediatrics 1/2009

Open Access 01-12-2009 | Review

Metabolic Bone Disease in preterm newborn: an update on nutritional issues

Authors: Valentina Bozzetti, Paolo Tagliabue

Published in: Italian Journal of Pediatrics | Issue 1/2009

Login to get access

Abstract

Osteopenia, a condition characterised by a reduction in bone mineral content, is a common disease of preterm babies between the tenth and sixteenth week of life. Prematurely born infants are deprived of the intrauterine supply of minerals affecting bone mineralization.
The aetiology is multifactorial: inadequate nutrients intake (calcium, phosphorus and vitamin D), a prolonged period of total parenteral nutrition, immobilisation and the intake of some drugs.
The diagnosis of metabolic bone disease is done by biochemical analysis: low serum levels of phosphorus and high levels of alkaline phosphatase are suggestive of metabolic bone disease. The disease can remain clinically silent or presents with symptoms and signs of rachitism depending on the severity of bone demineralisation.
An early nutritional intervention can reduce both the prevalence and the severity of osteopenia.
This article reviews the pathophysiology of foetal and neonatal bone metabolism, focuses on the nutrient requirements of premature babies and on the ways to early detect and treat osteopenia.
Appendix
Available only for authorised users
Literature
1.
Neonatal Research Network: Perinatal, mortality and morbidity information for infants born in the National Institute of child Health and Human Development (NICHD) Neonatal Research Network from 1997 to 2000. From Avery's disease of the Newborn. 2004, Elsevier Saunders, 3-5. 8
2.
Demarini S: Calcium and phosphorus nutrition in preterm infants. Acta Paediatr Suppl. 2005, 94 (449): 87-92. 10.1080/08035320510043619.CrossRefPubMed
3.
Mc Intosh N, DeCurtis M, Williams JR: Failure of mineral supplementation to reduce incidence of rickets in very low birth weight infants: conservative management and outcome. J Pediatr. 1989, 9: 326-9.
4.
Koo WWW, Sherman R, Succop P, Krug-Wispe S, Tsang RC, Steichen JJ, Crawford AH, Oestreich AE: Fractures and rickets in very low birth weight infants: conservative management and outcome. J Pediatr Orthop. 1989, 9 (3): 326-30.CrossRefPubMed
5.
Takada M, Shimada M, Hosono S: Trace elements and mineral requirements for very low birth weight infants in rickets of prematurity. Early Hum Dev. 1992, 29 (1-3): 333-338. 10.1016/0378-3782(92)90188-M.CrossRefPubMed
6.
Abrams AS: In utero physiology role in nutrient delivery and fetal development for calcium, phosphorus and vitamin D. Am J Clin Nutr. 2007, 85: 604S-7S.PubMed
7.
Portale AA: Blood calcium, phosphorus and magnesium. Primer on the metabolic bone diseases and disorders of mineral metabolism. Edited by: Favus MJ. 1999, Philadelphia: Lippincott William and Wilkins, 115-8. 4
8.
Greer FR, Tsang RG: Calcium, phosphorus and vitamin D requirements for the preterm infants. Vitamin and minerals requirements in preterm infants. Edited by: Tsang RC. 1985, NY: Marcel Deer, 99-136.
9.
Sparks JW: Human intrauterine growth and nutrient accretion. Semin Perinatol. 1984, 8: 74-93.PubMed
10.
Kovacs CS, Kronenberg HM: Maternal-fetal calcium and bone metabolism during pregnancy, puerperium and lactation. Endocr Rev. 1997, 18: 832-72. 10.1210/er.18.6.832.PubMed
11.
Care AD: The placental transfer of calcium. J Dev Physiol. 1991, 15: 253-7.PubMed
12.
Weisman Y, Harell A, Edelstein S, David M, Spirer Z, Golander A: 1 alpha, 25-Dihydroxyvitamin D3 and 24,25- Dihydroxyvitamin D3 in vitro synthesis by human deciduas and placenta. Nature. 1979, 281: 317-9. 10.1038/281317a0.CrossRefPubMed
13.
Rigo J, Senterre J: Nutritional needs of premature infants: current issues. J of Pediatrics. 2006, 149 (5 Suppl): S80-88. 10.1016/j.jpeds.2006.06.057.CrossRef
14.
15.
Koo WW, Walters JC, Esterlitz J, Levine RJ, Bush AJ, Sibai B: Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol. 1999, 94 (4): 577-582. 10.1016/S0029-7844(99)00371-3.CrossRefPubMed
16.
Rigo J, De Curtis M: Disorders of calcium, phosphorus and magnesium metabolism. Neonatal-Perinatal medicine: disease of the fetus and infanth. Edited by: Martin RJ, Fanaroff AA, Walsh MC. 2006, Philadelphia: Elsevier, 1492-1523. 8
17.
Toth P, Erdei G, Vasarhelyi B: Potential consequences of the sudden postnatal drop of estrogens level in preterm neonates. Orv Hetil. 2003, 144: 1719-24.PubMed
18.
American Academy of Pediatrics, Committee on Nutrition: Nutritional needs of LBW infants. Paediatrics. 1985, 75: 975-6.
19.
Hsu SC, Levine MA: Perinatal calcium metabolism: physiology and pathophysiology. Seminars in Neonatology. 2004, 9: 23-26. 10.1016/j.siny.2003.10.002.CrossRefPubMed
20.
Miller ME: Hypothesis: fetal movement influences fetal and infant bone strength. Med Hypotheses. 2005, 65: 880-6. 10.1016/j.mehy.2005.05.025.CrossRefPubMed
21.
Miller ME: The bone disease of preterm birth: a biomechanical perspective. Pediatr Res. 2003, 53 (1): 10-5.CrossRefPubMed
22.
Rauch F, Schoneau E: Skeletal development in premature infants a review of bone physiology beyond nutritional aspects. Arch Dis Child Fetal Neonatal Ed. 2002, 86 (2): F82-F85. 10.1136/fn.86.2.F82.PubMedCentralCrossRefPubMed
23.
Specker BL, Mulligan L, Ho M: Longitudinal study of calcium intake, physical activity and bone mineral content in infants 6–18 months of age. J Bone Miner Res. 1999, 14 (4): 569-576. 10.1359/jbmr.1999.14.4.569.CrossRefPubMed
24.
Weiler HA, Wang Z, Atkinson SA: Dexamethasone treatment impairs calcium regulation and reduces bone mineralization in infant pigs. Am J Clin Nutr. 1995, 61: 805-11.PubMed
25.
Zanardo V, Dani C, Trevisanuto D: Methylxanthines increase renal calcium excretion in preterm infants. Biol Neonate. 1995, 68: 169-74.CrossRefPubMed
26.
Venkataraman PS, Han BK, Tsang RC, Daugherty CC: Secondary hyperparathyroidism and bone disease in infants receiving long-term furosemide therapy. Am J Dis Child. 1983, 137: 1157-61.PubMed
27.
Riefen RM, Zlotkin S: Microminerals. Nutritional Needs of the Preterm Infant. Edited by: Tsang RC, Lucas A, Uauy R. 1993, Baltimore, Williams and Wilkins
28.
Rigo J, De Curtis M, Nyamugabo K, Pieltain C, Gerard P, Santerre J: Premature bone. Nutrition and bone development. Nestlè nutrition workshop Series. Edited by: Bonjour JP, Tsang RC. 1999, Philadelphia: Vevey/Lippincott-Raven, 41: 83-97.
29.
Koo WW, Tsang RC: Calcium, magnesium, phosphorus and vitamin D. Nutrition needs of preterm infant. Scientific basis and practical guidelines. Edited by: Tsang Rc, Lucas A, Uauy R, Zlotkin S. 1993, Baltimore: Williams & Wilkins, 135-155.
30.
Rigo J, De Curtis M, Pieltain C, Picaud J, Salle BL, Santerre J: Bone mineral metabolism in micropremie. Clin Perinatol. 2000, 27: 147-70. 10.1016/S0095-5108(05)70011-7.CrossRefPubMed
31.
Klein CJ: Nutrient requirements for preterm infants formulas. J Nutr. 2002, 1395S-577S. 32
32.
European Society of Paediatric Gastroenterology and Nutrition, Committee on Nutrition of the Preterm Infant: Nutrition and feeding of preterm infants. Acta Paediatr Scand Suppl. 1987, 336: 6-7.
33.
Atkinson S, Tsang RC: Calcium and phosphorus. Nutrition of the preterm infant: scientific basis and practice. Edited by: Tsang RC, Uauy R, Koletzko B, Zlotkin SH. 2005, Cincinnati: Digital Educational Publishing, 245-275. 2
34.
Rigo J, Pieltain C, Salle B, Senterre J: Enteral calcium, phosphate and vitamin D requirements and bone mineralization in preterm infants. Acta Paediatr. 2007, 969-974. 10.1111/j.1651-2227.2007.00336.x. 96
35.
Kuschel CA, Harding JE: Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database Syst Rev. 2004, 1: CD000343-PubMed
36.
37.
Bishop N: Bone disease in preterm infants. Arch Dis Child. 1989, 62: 1403-9. 10.1136/adc.64.10_Spec_No.1403.CrossRef
38.
Backstrom MC, Kouri T, Kuusela AL, Sievanen H, Kiovisto AM, Ikonen RS, Mäki M: Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr. 2000, 89 (7): 867-73. 10.1080/080352500750043792.CrossRefPubMed
39.
Ryan SW, Truscott J, Simpson M, James J: Phosphate, alkaline phosphatase and bone mineralization in preterm neonates. Acta Paediatr. 1993, 82 (6–7): 518-21. 10.1111/j.1651-2227.1993.tb12740.x.CrossRefPubMed
40.
Faerk J, Peitersen B, Petersen S, Michaelsen KF: Bone mineralisation in premature infants can be predicted from serum alkaline phopshatase or serum phosphate. Arch Dis Child Fetal Neonatal. 2002, 87 (2): F133-6. 10.1136/fn.87.2.F133.CrossRef
41.
Ardran GM: Bone destruction not demonstrable by radiography. Br J Radiol. 1951, 24 (278): 107-9. 10.1259/0007-1285-24-278-107.CrossRefPubMed
42.
Rigo J, Nyamugabo K, Picaud JC: Reference values of body composition obtained by DEXA in preterm and term neonates. J Pediatr Gastroenterol Nutr. 1998, 27: 184-90. 10.1097/00005176-199808000-00011.CrossRefPubMed
43.
Bruton JA, Bayleys HS, Atkinson SA: Validation and application of dual-energy X-ray absorpiometry tto measure bone mass and body composition in small infants. Am J Clin Nutr. 1993, 58: 839-45.
44.
Rubinacci A, Moro GE, Bohem G, De Terlizzi F, Moro GL, Cadossi R: Quantitative ultrasound for the assessment of osteopenia in preterm infants. Eur J Endocrinol. 2003, 149: 307-15. 10.1530/eje.0.1490307.CrossRefPubMed
45.
Kurl S, Heinonen K, Lansimies E: Pre- and post-discharge feeding of very preterm infants: impact on growth and bone mineralization. Clin Physiol Funct Imaging. 2003, 23: 182-9. 10.1046/j.1475-097X.2003.00493.x.CrossRefPubMed
46.
Lapillonne A, Salle BL, Glorieux FH, Claris O: Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term. Am J Clin Nutr. 2004, 80: 1595-603.PubMed
47.
Fewtrell MS, Prentice A, Jones SC, Bishop NJ, Stirling D, Buffenstein R, Lunt M, Cole TJ, Lucas A: Bone mineralization and turnover in preterm infants at 8–12 years of age: the effect of early diet. J Bone Miner Res. 1999, 14 (5): 810-20. 10.1359/jbmr.1999.14.5.810.CrossRefPubMed
48.
Chang JM, Armstrong C, Moyer-Mileur L, Hoff C: Growth and bone mineralization in children born prematurely. J Perinatol. 2008, 28 (9): 619-23. 10.1038/jp.2008.59.CrossRef
49.
Fewtrell MS, Cole TJ, Bishop NJ, Lucas A: Neonatal factors predicting childhood height in preterm infants: evidence for a persisting effect of early metabolic bone disease?. J Pediatr. 2000, 137 (5): 668-73. 10.1067/mpd.2000.108953.CrossRefPubMed
Metadata
Title
Metabolic Bone Disease in preterm newborn: an update on nutritional issues
Authors
Valentina Bozzetti
Paolo Tagliabue
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Italian Journal of Pediatrics / Issue 1/2009
Electronic ISSN: 1824-7288
DOI
https://doi.org/10.1186/1824-7288-35-20

Other articles of this Issue 1/2009

Italian Journal of Pediatrics 1/2009 Go to the issue

Review

Exhaled nitric oxide measurements in the first 2 years of life: methodological issues, clinical and epidemiological applications

Research

Lung disease assessment in primary ciliary dyskinesia: a comparison between chest high-field magnetic resonance imaging and high-resolution computed tomography findings

Research

Maturation of gastric electrical activity, gastric emptying and intestinal permeability in preterm newborns during the first month of life

Letter to the Editor

Staphylococcus aureus and autoimmune uveitis reactivation in childhood: a possible correlation?

Commentary

Isolated liver transplantation for treatment of liver failure secondary to intestinal failure

Commentary

Transplantation and innate immunity: the lesson of natural killer cells