Pediatric Influenza: Risks, Immunization Strategies, & Prevention Toddler Fever / Pain Management Texting, Tweeting, and Talking: E-communicati ...Genetic testing for intellectual disability: ... Preterm infants may need higher daily intake of vitamin D Preliminary data from a randomized, double-blind trial reveal that giving preterm babies daily supplementation of 800 international units (IU) of vitamin D reduces vitamin insufficiency that may lead to softening and weakening of their bones. At 40 weeks, a group of preterm infants receiving 800 IU of vitamin D3 showed lower insufficiency than a group receiving 400 IU (38% vs 67%, respectively) and the lower rate held at 3 months corrected age (12% vs 35%, respectively). Despite improvement in serum vitamin D levels in the 800 IU group, dual energy x-ray absorptiometry at 3 months did not reveal better bone mineralization. Natarajan CK, Sankar MJ, Agarwal R, et al. Daily vitamin D supplementation with 800 IU vs. 400 IU in preterm infants: a randomized trial.
Paper presented at: Pediatric Academic Societies Annual Meeting; INTRODUCTIONBone health is a critically important concern in the neonate, especially for premature infants who are at risk for rickets. Because of their rapid growth, all neonates when compared with older individuals have higher relative requirements of calcium (Ca) and phosphorus (P), which are critical components for bone structural integrity and growth. Preterm infants have even greater dietary requirements, as they need to compensate for the loss of accretion of these nutrients during the third trimester of pregnancy.The management of bone health in neonates, including preterm infants, will be reviewed here.BACKGROUNDNeonatal bone health is critical during this active period of growth. As a result, it is imperative that infants receive the necessary intake of the key nutrients calcium (Ca) and phosphorus (P) to ensure adequate mineralization for bone structural integrity and growth. The daily requirement of these nutrients is affected by the gestational age of the infant, and factors that affect intestinal absorption and urinary excretion.
Gestational age and placental transfer — During pregnancy, calcium and phosphorus are actively transferred from the mother to the fetus, reaching a peak accretion rate at 32 to 36 weeks gestation for calcium of 100 to 130 mg/kg of fetal weight per day, and for phosphorus, 60 to 70 mg/kg of fetal weight per day [1-4]. The third trimester is the period of most active growth and the increased accretion rate is in response to the higher fetal needs for the developing skeleton. As a result, requirements of Ca and P increase with decreasing gestational age to compensate for the loss of accretion of these minerals.In particular, extremely low birth weight (ELBW) infants (birth weights below 1000 g) or those born before 27 weeks gestation are at high risk for rickets [3,5,6]. Unfortified human milk, parenteral nutrition, and formulas designed for term infants do not contain enough Ca and P to fully meet the needs for bone mineralization in preterm infants. As a result, the use of these diets without further supplementation would limit bone growth, resulting in rickets, and potentially increase the risk of bone fractures.
(See 'Rickets in premature infants' below.) To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you: Medical Professional or Student The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. use of this website is governed by the UpToDate Terms of UseImportance of nutrition in development, with special reference to feeding low-birth-weight infants. In: Meeting Nutritional Goals for Low-Birth-Weight Infants, Sauls HS, Bachhuber WL, Lewis LA (Eds), Ross Laboratories, Columbus 1982. p.4.Ziegler EE, O'Donnell AM, Nelson SE, Fomon SJ. Body composition of the reference fetus. 40:329.Abrams SA, Committee on Nutrition.
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