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AAP Guidance on Calcium and Vitamin D Requirements of Preterm Infants

AAP Guidance on Calcium and Vitamin D Requirements of Preterm Infants

Summary of American Academy of Pediatrics guidance on calcium and vitamin D requirements of preterm infants

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Strategies should be in place to fortify human milk for preterm infants with birth weight < 1800 to 2000 g and to ensure adequate mineral intake during hospitalization and after hospital discharge.

Background:
In view of the unique bone mineral requirements of preterm infants, the American Academy of Pediatrics (AAP)published guidance for healthcare professionals to evaluate and manage preterm infants.

 

Summary of AAPguidance:

Preterm infants at high-risk of rickets

  • < 27 weeks’ gestation or birth weight < 1,000 g with a history of multiple medical problems.

Routine evaluation of bone mineral status

  • Biochemical testing, e.g. serum alkaline phosphatase activity (APA) should be indicated for infants with birth weight < 1,500 g, and started 4 to 5 weeks after birth.


Radiographic evaluation for rickets

  • Should be indicated for infants with serum APA > 800 to 1,000 IU/L or clinical evidence of fractures.


Phosphorus supplementation

  • Should be considered given to infants with a persistent phosphorus concentration of less than ~4.0 mg/dL.


Use of human milk fortified with minerals / formulas designed for preterm infants

  • Should be followed for infants with birth weight < 1,800 to 2,000 g:
    Calcium, mg/kg per day Phosphorus, mg/kg per day Vitamin D, IU per day
    150 - 220 75 - 140 200 - 400


Management after discharge from the hospital

  • A follow-up serum APA at 2 to 4 weeks after discharge from the hospital may be considered for preterm infants who were exclusively breastfed.


Vitamin D intakes for infants reach a body weight > 1,500 g and tolerate full enteral feeds

  • ~400 IU/day, and up to a maximum of 1,000 IU/day.

 

WYE-EM-004-JAN-15

Reference

Abrams SA; Committee on Nutrition. Calcium and vitamin d requirements of enterally fed preterm infants. Pediatrics. 2013 May;131(5):e1676-83. Link to PubMed