Investigation On Nutrients Supplementation In Neonates With High Risk Of Metabolic Bone Disease

BACKGROUND: Long-term usage of parenteral nutrition,diuretics and hormones are the risk factors for the lack of calcium and phosphorus supplementation in premature infants and very low birth weight(VLBW)infants,among which long-term use of parenteral nutrition is a high risk factor.This study intended to enroll preterm and VLBW infants who were administrated with parenteral nutrition for more than 4 weeks in the NICU of Shanghai Children’s Medical Center.This is a retrospective case analysis which investigated the current situation of nutrients supplementation for the children with high risk of metabolic bone disease by regular monitoring of serum alkaline phosphatase,serum phosphorus and bone mineral density,also monitoring whether the enteral and parenteral nutrients supplementations were sufficient and weight gain during hospitalization.MATERIALS AND METHODS: Retrospective screening was conducted in the NICU in Shanghai Children’s Medical Center from 2014 to 2016.Neonates whose birth weight was less than 1500 g or gestational age less than 32 weeks,along treated with parenteral nutrition for more than four weeks were enrolled;40 cases of boys,36 girls were enrolled,whose gestational age varied from 26 to 34 weeks and birth weight varied from 900 g to 1500 g.We investigated the amount of calcium and phosphorus supplemented(including enteral and parenteral)during hospitalization.Weekly serum levels of alkaline phosphatase,serum phosphorus were recorded and bone mineral density was measured which indicated the level of bone development and the risk of metabolic bone disease in neonates.We also calculate the duration of parenteral nutrition in neonates during the hospital,calorie(enteral + parenteral)intake,calcium and phosphorus intake,vitamin D supplement,analyzed if there is administer calcium and phosphorus when levels of blood alkaline phosphatase and serum levels change,and its correlation with weight change during hospitalization.Results: The amount of clinical calcium and phosphorus supplementations(including enteral and parenteral)failed to meet the international guideline.Rational supplement of calcium for high risk children with metabolic bone disease was low:the supplement of calcium per kilogram of an average of 19.3mg /(kg · d)[7.36 mg /(Kg · d)-32.66 mg /(kg · d)],where PN calcium accounted for 10%-25% of the total calcium supplement;the daily amount of phosphorus per kilogram was 14.84 mg /(kg · d)(4.99 mg /(kg · d)-32.22 mg /(kg · d)),50% of which is less than 15 mg /(kg · d).The indicators for early screening for metabolic bone disease of AKP were 94%,73%,57%,52% and 26%,respectively,from the first week to the fifth week.The monitoring ratio of serum calcium was 18.4%,21.2%,19.7%,21.0% and 13.1%,respectively.The monitoring ratio of serum phosphorus was 21.0%,21.0%,14.4%,10.5% and 10.5%,respectively.Neither vitamin D nor bone mineral density were measured.The daily vitamin D supplementation was 500IU(2 weeks after the birth).Discussion: Rational supplementation of calcium and phosphorus were beneficial for high risk neonates of metabolic bone disease in terms of the growth and development.Currently the amount of clinical calcium and phosphorus supplementations(including enteral and parenteral)failed to meet the international guideline.This survey found that clinical deficiency on risk assessment,monitoring and intervention regarding neonates with high risk of bone metabolic disease.We recommend that regularly monitoring the blood alkaline phosphatase,serum phosphorus,calcium,25-OH vitamin D levels and bone mineral density,as well as calcium and phosphorus supplementation should be beneficial for the neonates growth and development with high risk of metabolic bone disease.