Metabolic bone disease as a complication of nutritional treatment of preterm newborn – a case study

The subject of this study is a premature infant (25 hdb) who had four long bone fractures at the age of 5 months. Until then the infant had been fed parenterally or with casein hydrolysate. Apart from that, the child underwent: congenital intrauterine infection, breathing disorder complex, II/III degree intraventricular haemorrhage, operational treatment of patent ductus arteriosus and necrotising enterocolitis (I degree). When the fractures were noticed the parameters of calcium-phosphate metabolism showed severe preterm osteopenia: Ca (serum) – 2.56 mmol/l, HPO4 (serum) – 0.71 mmol/l, Ca (urine) – 11.45 mmol/l, HPO4 (urine) – 0.4 mmol/l, TRP index – 98.3%, calcium-creatine index – 2.33 mmol/ mmol, alkaline phosphatase – 996 U/l, parathormone – 419.7 pg/ml, 25(OH)D3 – 149.6 ng/ml. In the therapeutic process infant formula was changed to Bebilon Neonatal, Bebilon BMF was used, initially Devisol was included and then L-calcidiol, intravenous calcium and phosphates supply was increased (to 2 mmol/kg/day), which led to an improvement of calcium-phosphate homeostasis. Concurrently, the fractured bones were conservatively treated under orthopaedic control. This case study unambiguously points to a need for an increase and a proper balancing of calcium, phosphates and protein in parenteral and enteral feeding of preterm infants and an arbitrary need for systematic monitoring of calcium-phosphate metabolism in this age group.