Magnesium metabolism in preterm infants: effects of calcium, magnesium, and phosphorus, and of postnatal and gestational age.

This study tests the hypothesis that increasing the calcium and phosphorus content of formulas for very low birth weight (VLBW) infants to the level required to decrease the incidence of rickets has a negative impact on magnesium balance. Using formulas variously supplemented with these minerals, we measured absorption and retention in two groups of preterm infants: (1) VLBW infants, less than 1500 gm and at less than 32 weeks of gestational age, with 3-day mineral balances begun at days 10, 20, 30, and 40; and (2) low birth weight infants appropriately grown and at 32 to 34 weeks of gestational age, with a single 3-day balance begun at day 10. Magnesium did not affect calcium balance in VLBW or low birth weight infants but promoted phosphorus retention in VLBW infants from day 20 onward. Absorption and retention of magnesium increased with postnatal age in VLBW infants, but this effect was obvious only when calcium or phosphorus intakes were low or when magnesium intake was high. Calcium and phosphorus supplementation further reduced magnesium absorption and retention in VLBW infants to the extent that they were in negative balance throughout the study; however, magnesium supplementation improved absorption and retention in VLBW infants. The low birth weight infants absorbed and retained more magnesium than VLBW infants at the same postnatal age whether or not magnesium was supplemented. We conclude that magnesium deficits occur at currently recommended intakes of 10 mg/kg/day for VLBW infants with calcium and phosphorus intakes that allow retentions equivalent to in utero accretions; however, with magnesium intakes approaching 20 mg/kg/day, appropriate retention can be achieved.