Osteopenia of prematurity is a common occurrence. It is believed to be mainly a result of a lack of substrate (Calcium) to the growing bones rather than vitamin D deficiency.
Severe cases are still encountered despite careful nutritional support.
Some colleagues advocate using a "high" dose of Vitamin D (thousands of units) with little or no evidence other than their "experience". Do you subscribe to this practice? Any good evidence?
Not enough vitamin D = not enough calium for growing bones.
Extensive nutritional support just does not exist. You have to suplenent. Very conservative IOM recommendations say about 1000 IU/day with Tolerable Upper Limit set at 4000 IU/d
very interesting question. WE ahve found that some babies even on regular vit d supplements can get extremely high vit d levels and we are very concenred about the sequelae. There is no evidence that targeting vitamin d alone improves osteopenia of prematurity as diuretics, sepsis etc playa arole. Therefore in short we just use regulare supplementation ie 200iu orally
bw
eleanor
For babies 200IU is certainly OK. I meant young adults and adults.
I agree that that vitamin D alone (without sufficient calcium intake) will not do.
There is a growing body of evidence for a non-calcemic actions of vitamin D.
J.Ł
Indeed the lack of substrate (calcium, phosphate) is the main reason for osteomalacia and rickets, so recommended intakes of these, in particular in premature babies, should be followed. Vitamin D is (only) the supplier of these minerals by increasing their gut absorption. The standard RDA for vitamin D in babies is between 400 to 600 units (see IOM or Endocrine Society guidance). Aim to keep 25OHD levels >50nmol/L whatever the dose. Premature babies may require more, esp. if born to D-deficient mothers which is common in Saudi Arabia.
thanks for the insights! I have attached bellow three relatively old studies but of relevance to our discussion. some salient points:
1- Increasing vitamin D intakes to 960 IU/day or higher has not proved beneficial
Evans JR, Allen AC, Stinson DA, et al. Effect of high-dose vitamin D supplementation on radiographically detectable bone disease of very low birth weight infants. J Pediatr. 1989;115:779.
2- Preterm infants on long-term TPN have exhibited adequate vitamin D status on solutions supplying as little as 30 to 35 IU/kg per day
Backstrom MC, Maki R, Kuusela A-L, et al. Randomized controlled trial of vitamin D supplementation on bone density and biochemical indices in preterm infants. Arch Dis Child Fetal Neonatal Ed.1999, 80:F161.
3- [TPN] Solutions containing 60 mg/dL (15 mmol) of calcium and 46 mg/dL (15 mmol) of phosphorus will maintain the desired biochemical and calciotropic hormone indices of mineral homeostasis.
Koo WWK, Tsang RC, Succop P, et al. Minimal vitamin D and high calcium and phosphorus needs of preterm infants receiving parenteral nutrition. J Pediatr Gastroenterol Nutr. 1989;8:225.
There is no evidence that vitamin d alone improves osteopenia of prematurity e. Therefore in short we just use regulare supplementation ie 200iu orally.
Guidelines for the Treatment of Osteopenia of Prematurity 3,5
1. Prescribe:
Elemental calcium 2.5 - 4 mmol/kg/day and
Elemental phosphate 2 - 3 mmol/kg/day to be given in divided doses.
N.B. Calcium and phosphate must not be given at the same time (because they may precipitate), so in practice should be given at alternate feeds.
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