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.
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.
- 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.
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