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Vitamin D, bone density, and nephrocalcinosis in preterm infants: a prospective study

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Abstract

Background

Vitamin D (VitD) supplementation is recommended by the American Academy of Pediatrics (AAP) for preterm infants to improve bone density. Complications of VitD supplementation include hypercalciuria and nephrocalcinosis (NC). NC has been reported in 7–64% infants < 32 weeks gestational age (GA) or < 1500 g birth weight (BW). The relationships between VitD supplementation, serum 25-hydroxy VitD levels, bone density, hypercalciuria and development of NC in preterm infants are not well established.

Methods

Prospective, observational cohort study of 56 infants with GA ≤ 32 weeks or BW ≤ 1800 g. Demographics, dietary intakes, serum 25-hydroxy VitD levels and weekly urinalyses were collected until 40 weeks corrected GA or discharge. Bone mineral density (BMD) and content (BMC) were assessed using dual-energy X-ray absorptiometry (DEXA) scan. NC was identified by kidney ultrasound.

Results

56 infants received on average 447 IU/day of VitD with average serum 25-hydoxy VitD level 39.6 ng/mL. DEXA scan showed average BMD 0.13 g/cm2 and BMC 35.8 g. 23/56 (41%) infants were diagnosed with NC. Infants with NC had lower GA (p < 0.01) and BW (p < 0.01) and increased presence of calcium oxalate crystals (78% vs. 36%) (p = 0.002). There were no differences in VitD intake, urine calcium/creatinine ratios or BMD and BMC in infants with versus without NC.

Conclusions

VitD supplementation per AAP guidelines resulted in acceptable serum 25-hydroxyVitD levels, but no improvement in BMD or BMC compared to previously reported values. However, infants receiving recommended amounts born at earlier GA and lower BW are at increased risk of NC. VitD supplementation and serum levels should be closely monitored in this high-risk population.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Funding

Intermountain Research and Medical Foundation and the University of Utah Division of Neonatology. The statistician was supported by the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764).

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Sabrina Malone Jenkins & Gary Chan

  2. Women and Newborn’s Clinical Program, Intermountain Healthcare, Murray, UT, USA

    Kimberlee Weaver-Lewis

  3. CCTS Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA

    Tyler Bardsley

  4. University of Utah, Salt Lake City, UT, USA

    Jace Felix

  5. Division of Nephrology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    Matthew Grinsell

Authors
  1. Sabrina Malone Jenkins
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  2. Gary Chan
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  3. Kimberlee Weaver-Lewis
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  4. Tyler Bardsley
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Contributions

SMJ conceptualized and designed the study, recruited patients, collected data, did the initial analysis, and drafted the initial manuscript. MG conceptualized and designed the study, interpreted kidney ultrasounds, completed the analysis and interpretation of data, and reviewed and revised the manuscript. GC conceptualized and designed the study, analyzed and interpreted the data, and reviewed and revised the manuscript. He approved of the final manuscript prior to his death. KWL conceptualized the study, recruited patients, collected and analyzed data, and reviewed and revised the manuscript. TB carried out the statistical analysis and data interpretation, and reviewed and revised the manuscript. JF acquired and analyzed the data, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sabrina Malone Jenkins.

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The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest relevant to this article to disclose.

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Approved by the Intermountain IRB.

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Written informed consent was obtained from the parents.

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Malone Jenkins, S., Chan, G., Weaver-Lewis, K. et al. Vitamin D, bone density, and nephrocalcinosis in preterm infants: a prospective study. Pediatr Nephrol 37, 1325–1332 (2022). https://doi.org/10.1007/s00467-021-05300-8

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  • DOI: https://doi.org/10.1007/s00467-021-05300-8

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