Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX, USA.
Early Hum Dev. 2021 Nov;162:105461. doi: 10.1016/j.earlhumdev.2021.105461. Epub 2021 Sep 2.
Osteopenia and rickets remain a problem for high-risk infants, especially preterm infants <1500 g birthweight (very low birth weight, VLBW). The primary cause of osteopenia in VLBW infants is a low intake of calcium and phosphorus compared to requirements for the rapidly growing skeleton. Human milk is a relatively low mineral containing substance and cannot meet the bone mineral needs of very low birth weight infants. As such, most VLBW infants need additional bone minerals and in many neonatal care units these are provided as part of human milk fortificants or specialized infant formulas. In some nurseries, these are given to all infants < 1800-2000 g birthweight. Management of full-term infants who are small for gestational age at birth is less clear, but in general bone mineral content is associated more with body size than gestational age and supplementation is often provided to these infants. Although all infants, including preterm ones need a source of vitamin D, the benefits of providing high doses of vitamin D to healthy preterm neonates is unproven. Some evidence indicates that most calcium absorption is non-vitamin D dependent in the first weeks of life in both preterm and term infants. However, after achieving full feeds in the preterm infant, it is prudent to provide vitamin D at amounts comparable to that used in full-term infants. Higher doses increase serum 25-hydroxyvitamin D levels more rapidly, but evidence is inconclusive as to the relative benefits vs possible risks of higher doses. In healthy full-term infants, although vitamin D provision via supplement drops to the breastfed infant, high dose maternal supplementation to the lactating mother or infant formula is generally recommended, the current evidence only strongly supports its use in identified at-risk infants.
骨质疏松症和佝偻病仍然是高危婴儿（尤其是出生体重<1500 克的早产儿）的问题。极低出生体重（VLBW）婴儿骨质疏松的主要原因是与快速生长的骨骼相比，钙和磷的摄入量较低。人乳是一种矿物质含量相对较低的物质，无法满足极低出生体重婴儿的骨骼矿物质需求。因此，大多数 VLBW 婴儿需要额外的骨骼矿物质，在许多新生儿护理单位，这些矿物质是通过人乳强化剂或特殊婴儿配方奶粉提供的。在一些托儿所，这些都提供给出生体重<1800-2000 克的所有婴儿。对于出生时小于胎龄的足月婴儿的管理则不太明确，但一般来说，骨骼矿物质含量与体型的关系大于与胎龄的关系，通常会为这些婴儿提供补充剂。虽然所有婴儿，包括早产儿，都需要维生素 D 的来源，但向健康的早产儿提供高剂量维生素 D 的益处尚未得到证实。一些证据表明，在早产儿和足月儿生命的头几周，大多数钙吸收与维生素 D 无关。然而，在早产儿实现全母乳喂养后，提供与足月儿相当量的维生素 D 是谨慎的。较高剂量会更快地增加血清 25-羟维生素 D 水平，但较高剂量的相对益处与可能的风险之间的证据尚无定论。在健康的足月婴儿中，尽管通过补充滴剂向母乳喂养的婴儿提供维生素 D，但通常建议对哺乳期母亲或婴儿配方奶粉进行高剂量的补充，目前的证据仅强烈支持在确定有风险的婴儿中使用。
