Kolisambeevi Arif Abdulsalam, Pournami Femitha, Prithvi Ajai Kumar, Nandakumar Anand, Prabhakar Jyothi, Jain Naveen
Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala.
Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala. Correspondence to: Dr Femitha Pournami, Consultant and Academic Coordinator, Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum 695 029, Kerala.
Indian Pediatr. 2022 Nov 15;59(11):841-846. Epub 2022 Sep 9.
Metabolic bone disease (MBD) is a morbidity of multifactorial etiology with a high incidence in very preterm infants. We planned to study the incidence of MBD after implementation of bone health focussed nutritional strategy (BNS) in those <30 weeks gestation at birth.
This prospective cohort study including preterm newborns (<30 weeks) who received nutrition that incorporated (a) Early initiation of intravenous potassium phosphate; (b) Early enteral supplementation with multicomponent human milk fortifier at enteral feed tolerance of 40 mL/kg/day feeds itself; and (c) Weekly phosphorus measurements with optimization of enteral intakes. Incidence of MBD at 4 weeks of postnatal age and beyond were analyzed. Other relevant safety and clinical outcomes were measured.
Of the 67 included neonates receiving BNS, 20.9% were classified as MBD. There was a low rate of hyper-phosphatemia (4.5%) and hyperkalemia (2.9%). Full enteral feeds were achieved by median (IQR) of 6 (5,7) postnatal days.
In preterm newborns (24-30 weeks) MBD incidence was 20.9% after BNS was implemented. Intravenous potassium salt of phosphorus and early use of HMF were safe and feasible.
代谢性骨病（MBD）是一种病因多因素的疾病，在极早产儿中发病率很高。我们计划研究在出生时孕周<30周的婴儿中实施以骨骼健康为重点的营养策略（BNS）后MBD的发病率。
这项前瞻性队列研究纳入了孕周<30周的早产新生儿，他们接受的营养方案包括：（a）早期静脉输注磷酸钾；（b）在肠道喂养耐受量达到40 mL/kg/天自身喂养量时，早期经肠道补充多成分人乳强化剂；（c）每周进行磷测量并优化肠道摄入量。分析出生后4周及以后MBD的发病率。测量其他相关的安全性和临床结局。
在67例接受BNS的新生儿中，20.9%被归类为患有MBD。高磷血症发生率较低（4.5%），高钾血症发生率较低（2.9%）。出生后中位数（四分位间距）6（5，7）天实现完全经肠道喂养。
在孕周24 - 30周的早产新生儿中，实施BNS后MBD发病率为20.9%。静脉输注磷的钾盐以及早期使用人乳强化剂是安全可行的。
