Osteomalacia of very-low-birth-weight infants.

Neonatal osteomalacia has received scant attention in the orthopedic literature, despite a reported incidence of 13-32% in very-low-birth-weight infants. This retrospective study focused on the calcium, phosphorus, and vitamin D metabolism of 10 surviving infants up to 28 weeks old born over a 30-month period. Clinical and radiologic evidence of osteomalacia appeared to be related to the intake of calcium and phosphorus. The lower the amount of mineral intake, the more severe was the clinical appearance of rickets. The amount of vitamin D intake, although low, did not correlate with the degree of clinical or radiographic abnormalities noted in these infants. There was an orderly appearance of radiographic changes that were dependent on the amount of mineral depletion. Recognition and identification of the early radiographic findings may lead to the early diagnosis and treatment of osteomalacia in the very-low-birth-weight infant. Prevention of fractures resulting from calcium, phosphorus, or vitamin D deficiency is the goal of early therapy.