Hypothesis
@EN If calcium and phosphorus were administered to very low birth weight infants in amounts more than those currently used in the standard parenteral nutrition solution, the apparent retention of calcium and phosphorus will be increased and the
bone
mineralization will be improved in these very low birth weight infants.
@ES Patients
@EN Fifteen very low birth weight infants (<1,500gm) who were admitted to NICU at Asan Medical Center from February 1994 to August 1994 were recruited for the study. All of these infants required more than 2 weeks of parenteral nutrition therapy.
@ES Methods
@EN Those infants who received parenteral nutrition were divided into 2 groups: The standard supplement group (n=7, mean gestational age 28.6±2.1 weeks mean birth weight 1,195±258mg), and high supplement group (n=8, mean gestational age
30.3±1.3
weeks, mean birth weight 1,129±197gm). The amount of elemental calcium supplied in the standard supplement group and high supplement group were 45mg/kg/day ad 90mg/kg/day, respectively and the ratio of calcium to phosphorus in parenteral
nutrition
solution was 1.7:1 in both groups. The level of serum calcium, phophorus, and alkiline phosphatase was measured on 3rd and 14th day of the parenteral nutrition along with the urinary excretion of 24 hour calcium and phosphorus to estimate the
retention
of calcium and phosphorus in the body.
The x-ray of the wrist was taken on 4th week of parenteral nutrition to see the mineralization of the bone and the changes for rickets. The sacral bone density was measured in both groups prior to discharge by using DPA (double-photon
absorptiometry)
when infants reached 1,800-2,000gm.
@ES Results
@EN 1) There were no differences in the serum concentration of calcium, phosphorus and alkaline phosphatase on 3rd and 14th day of parenteral nutrition between the standard and high supplement group. Both groups had similar values of the urinary
excretion of calcium, phosphorus and the tubular reabsorption of phosphorus on 3rd and 14th day of parenteral nutrition.
2) The retentions of calcium and phosphorus which were checked on 3rd and 14th day of parenteral nutrition were significantly higher in the high supplement group than the standard group and this finding was statistically significant at p<0.05.
3) The radiographic findings of the rickets and osteopenia were more frequently observed in the standard supplement group than the high supplement group. Both bone mineral content(BMC) and bone mineral density(BMD) as measured by DPA were
significantly
higher in the high supplement group than the standard group(p<0.05).
@ES Conclusion
@EN The parenteral nutrition supply of high concentration of calcium and phosphorus in very low birth weight infant increased the retention of these minerals in the body, hence increasing the bone mineral contents. However, this study has its
limitation
due to small number of patients enrolled, therefore, further study is required to observe the effect of parenteral supply of calcium and phosphorus therapy on ineral retention and bone mineral content in very low birth weight infants.
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