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Nutrients 2017, 9(12), 1318; doi:10.3390/nu9121318

Growth and Bone Mineralization of Very Preterm Infants at Term Corrected Age in Relation to Different Nutritional Intakes in the Early Postnatal Period

1
Department of Paediatrics, Subdivision of Neonatology, Radboudumc Amalia Children’s Hospital, Radboud University Medical Center, P.O. Box 9101, Internal Postal Code 804, 6500 HB Nijmegen, The Netherlands
2
Department for Health Evidence, Radboud Institute for Health Science, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
3
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
4
Department of Paediatrics, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
5
Department of Paediatrics, Emma Children’s Hospital—Academic Medical Center (AMC), 1105 AZ Amsterdam, The Netherlands
*
Author to whom correspondence should be addressed.
Received: 9 November 2017 / Revised: 27 November 2017 / Accepted: 28 November 2017 / Published: 2 December 2017
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Abstract

Preterm infants often have a reduced bone mineral content (BMC) with increased risk of metabolic bone disease. After birth it is difficult to supply calcium (Ca) and phosphorus (P) comparable to the high fetal accretion rate. It is not known whether high supplementation of minerals in the early postnatal period improves growth and bone mineralization. The aim of this study was to evaluate growth and bone mineralization at term corrected age (TCA) in very and extremely preterm infants who received different enteral Ca and P intakes during the first 10 days of life. Infants (n = 109) with birth weights below 1500 g were randomly assigned to one of three groups that differed in the nutritional protocols delivered until day 10: Group A, mother’s own milk (MOM) and donor milk (unfortified); Group B, MOM (unfortified) and preterm formula; Group C, MOM (start fortification >50 mL/day) and preterm formula. Due to the earlier commencement of fortification, Group C received higher intakes of calcium and phosphorus and protein (p < 0.001) until day 10. At TCA weight, length, BMC and bone mineral density (BMD), measured by dual-X-ray absorptiometry, were not different between the groups. Nutritional intake of P was positively associated with length (β; (95% confidence interval (CI): 0.20 (0.001; 0.393); p-value = 0.048), whereas Ca intake was negatively associated with BMC (−1.94 (−2.78; −1.09); p-value < 0.001). A small interaction between Ca and P intake was only found for BMD (0.003 (0.00002; 0.00006); p-value = 0.036). The volume of human milk per kg provided during the first 10 days was positively associated with BMC (β; (95% CI): 0.013 (0.002; 0.023); p < 0.017). Higher intakes of Ca and P during the first 10 days, as provided in this study, did not improve bone mineralization at term corrected age. View Full-Text
Keywords: calcium; phosphorus; bone mineral density; weight; length; human milk; fortification; preterm formula; dual-X-ray absorptiometry calcium; phosphorus; bone mineral density; weight; length; human milk; fortification; preterm formula; dual-X-ray absorptiometry
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Körnmann, M.N.; Christmann, V.; Gradussen, C.J.W.; Rodwell, L.; Gotthardt, M.; Van Goudoever, J.B.; Van Heijst, A.F.J. Growth and Bone Mineralization of Very Preterm Infants at Term Corrected Age in Relation to Different Nutritional Intakes in the Early Postnatal Period. Nutrients 2017, 9, 1318.

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