Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Jun;37(6):1325-1332.
doi: 10.1007/s00467-021-05300-8. Epub 2021 Oct 1.

Vitamin D, bone density, and nephrocalcinosis in preterm infants: a prospective study

Sabrina Malone Jenkins  1 , Gary Chan  2 , Kimberlee Weaver-Lewis  3 , Tyler Bardsley  4 , Jace Felix  5 , Matthew Grinsell  6
Affiliations
Observational Study

Vitamin D, bone density, and nephrocalcinosis in preterm infants: a prospective study

Sabrina Malone Jenkins et al. Pediatr Nephrol. 2022 Jun.

Abstract

Background: Vitamin D (VitD) supplementation is recommended by the American Academy of Pediatrics (AAP) for preterm infants to improve bone density. Complications of VitD supplementation include hypercalciuria and nephrocalcinosis (NC). NC has been reported in 7-64% infants < 32 weeks gestational age (GA) or < 1500 g birth weight (BW). The relationships between VitD supplementation, serum 25-hydroxy VitD levels, bone density, hypercalciuria and development of NC in preterm infants are not well established.

Methods: Prospective, observational cohort study of 56 infants with GA ≤ 32 weeks or BW ≤ 1800 g. Demographics, dietary intakes, serum 25-hydroxy VitD levels and weekly urinalyses were collected until 40 weeks corrected GA or discharge. Bone mineral density (BMD) and content (BMC) were assessed using dual-energy X-ray absorptiometry (DEXA) scan. NC was identified by kidney ultrasound.

Results: 56 infants received on average 447 IU/day of VitD with average serum 25-hydoxy VitD level 39.6 ng/mL. DEXA scan showed average BMD 0.13 g/cm2 and BMC 35.8 g. 23/56 (41%) infants were diagnosed with NC. Infants with NC had lower GA (p < 0.01) and BW (p < 0.01) and increased presence of calcium oxalate crystals (78% vs. 36%) (p = 0.002). There were no differences in VitD intake, urine calcium/creatinine ratios or BMD and BMC in infants with versus without NC.

Conclusions: VitD supplementation per AAP guidelines resulted in acceptable serum 25-hydroxyVitD levels, but no improvement in BMD or BMC compared to previously reported values. However, infants receiving recommended amounts born at earlier GA and lower BW are at increased risk of NC. VitD supplementation and serum levels should be closely monitored in this high-risk population. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Bone density; Nephrocalcinosis; Preterm Infants; Vitamin D.

PubMed Disclaimer

References

    1. Bozzetti V, Tagliabue P (2009) Metabolic bone disease in preterm newborn: an update on nutritional issues. Ital J Pediatr 35:20 - DOI
    1. Abrams SA, Bhatia J, Corkins M, de Ferranti S, Golden N, Silverstein J (2013) Calcium and vitamin d requirements of enterally fed preterm infants. Pediatrics 131:e1676-1683 - DOI
    1. Cooke RJ, Rawlings DJ, McCormick K, Griffin IJ, Faulkner K, Wells JC, Smith JS, Robinson SJ (1999) Body composition of preterm infants during infancy. Arch Dis Child Fetal Neonatal Ed 80:F188-191 - DOI
    1. Schell-Feith EA, Kist-van Holthe JE, van der Heijden AJ (2010) Nephrocalcinosis in preterm neonates. Pediatr Nephrol 25:221–230 - DOI
    1. Rowe J, Rowe D, Horak E, Spackman T, Saltzman R, Robinson S, Philipps A, Raye J (1984) Hypophosphatemia and hypercalciuria in small premature infants fed human milk: evidence for inadequate dietary phosphorus. J Pediatr 104:112–117 - DOI

Publication types

LinkOut - more resources