Abstract
Ninety-eight percent of the calcium and eighty percent of the phosphorus in the body are in the skeleton; these elements are also constituents of the intracellular and extracellular spaces. The metabolic homeostasis of calcium, phosphorus, and magnesium and mineralization of the skeleton are complex functions that require the intervention of various parameters; an adequate supply of nutrients; the development of the intestinal absorption process; and the effects of several hormones, such as parathyroid hormone, vitamin D, and calcitonin, as well as optimum renal and skeletal controls [1]. Bone formation requires protein and energy for collagen matrix synthesis, and an adequate intake of calcium and phosphorus is necessary for correct mineralization. During development, nutrients are transferred mainly across the placenta. It has been calculated that during the last trimester of gestation the daily accretion per kilogram of body weight represents around 120 mg of calcium and 70 mg of phosphorus. Therefore, at birth the whole-body content of a term infant represents approximately 30 grams of calcium and 16 grams of phosphorus. After birth, the use of the gastrointestinal tract to provide nutrients for growth causes a reduction in calcium availability for bone accretion promoting the occurrence of relative osteopenia in preterm infants and to a lesser extent in term infants during the first weeks of life. In addition to their roles in bone formation, calcium and phosphorus play important roles in many physiologic processes, such as transport across membranes, activation and inhibition of enzymes, intracellular regulation of metabolic pathways, secretion and action of hormones, blood coagulation, muscle contractility, and nerve conduction. The 20% of phosphorus not complexed within bone is present mainly as adenosine triphosphate, nucleic acids, and cell and organelle membranes.
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References
Rigo J, De Curtis M, Pieltain C et al (2000) Bone mineral metabolism in the micropremie. Clin Perinatol 27: 147–170
Rigo J, Mohamed MW, De Curtis M (2010) Disorders of calcium, phosphorus, and magnesium metabolism. In: Martin R, Fanaroff A, Walsh M (eds) Neonatal-Perinatal Medicine, 9th edn. Elsevier Mosby, Philadelphia
Hsu SC, Levine MA (2004) Perinatal calcium metabolism: physiology and pathophysiology. Sem Neonatol 9: 23–36
Sato K (2008) Hypercalcemia during pregnancy, puerperium, and lactation: review and a case report of hypercalcemic crisis after delivery due to excessive production of PTH-related protein (PTHrP) without malignancy (humoral hypercalcemia of pregnancy). Endocr J 55: 959–966
Avila E, Diaz L, Barrera D et al (2006) Regulation of vitamin D hydroxylaxses gene expression by 1,25-dihydroxyvitamin D3 and cyclic AMP in cultured human syncytiotrophoblasts. J Steroid Biochem Mol Biol 103: 90–96
Novakovic B, Sibson M, Hg HK et al (2009) Placenta-specific methylation of the vitamin D 24-hydroxylase gene: implications for feedback autoregulation of active vitamin D levels at the feto- maternal interface. J Biol Chem 284: 14838–14848
Salle BL, Delvin EE, Lapillonne A et al (2000) Perinatal metabolism of vitamin D. Am J Clin Nutr 71: 1317S–1324S
Bassir M, Laborie S, Lapillonne A et al (2001) Vitamin D defi-ciency in Iranian mothers and their neonates: A pilot study. Acta Paediatr 90: 577–579
Atkinson SA, Tsang RC (2005) Calcium, magnesium, phosphorus, and vitamin D. In: Tsang R et al (eds) Nutrition of the Preterm Infant, 2nd edn. Digital Educ Pub, Cincinnati, Ohio, p 245
Rigo J, Senterre J (2006) Nutritional needs of premature infants: current issues. J Pediatr 149: S80–S88
Rigo J, Pieltain C, Salle B, Senterre J (2007) Enteral calcium, phosphate and vitamin D requirements and bone mineralization in preterm infants. Acta Paediatr 96: 969–974
Portal AA (2004) Calcium and phosphorus. In: Avner ED, Harmon WE, Niaudet P et al (eds) Pediatric Nephrology, 5th edn. Lippincott, Williams and Wilkins, Philadelphia, p 209
American Academy of Pediatric (1985) Committee on Nutrition: Nutritional needs of low birth weight infants. Pediatrics 75: 976
Klein CJ (2002) Nutrient requirements for preterm infant formulas. J Nutr 132: 1395S–1577S
Agostoni C, Buonocore G, Carnielli VP et al (2010) Enteral nutrient supply for preterm infants. J Pediatr Gastroenterol Nutr 50: 85–91
Holtback U, Aperia AC (2003) Molecular determinants of sodium and water balance during early human development. Sem Neonatol 8: 291–299
Quarles LD (2008) Endocrine functions of bone in mineral metabolism regulation. J Clin Invest 118: 3820–3828
Rodriguez SJ (2003) Neonatal hypercalcemia. J Nephrol 16: 606–608
Pieltain C, Vervoort A, Senterre T, Rigo J (2009) Intérêt de la consommation de produits laitiers et de la supplémentation en vitamine D au cours de la croissance. J Pédiatr Belge 11: 24–27
Pawley N, Bishop NJ (2004) Prenatal and infant predictors of bone health the influence of vitamin D. Am J Clin Nutr 80 (Suppl 6): 1748S–1751S
Greer FR (2003) Vitamin D deficiency-it’s more than rickets. J Pediatr 143: 422–423
Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition (2008) Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 122: 1142–1152
Holick MF (2007) Vitamin Deficiency. N Engl J Med 357: 266–281
Karsdal MA, Henriksen K, Arnold M, Christiansen C (2008) Calcitonin: a drug of the past or for the future? Physiologic inhibition of bone resorption while sustaining osteoclast numbers improves bone quality. BioDrugs 22: 137–144
Fudge NJ, Kovacs CS (2004) Physiological studies in heterozygous calcium sensing receptor ( CaSR) gene-ablated mice confirm that the CaSR regulates calcitonin release in vivo. BMC Physiol 20: 5
Liu S, Gupta A, Quarles LD (2007) Emerging role of fibroblast growth factor 23 in a bone-kidney axis regulating systemic phosphate homeostasis and extracellular matrix mineralization. Curr Opin Nephrol Hypertens 16: 329–335
Shaikh A, Berndt T, Kumar R (2008) Regulation of phosphate homeostasis by the phosphatonins and other novel mediators. Pe- diatr Nephrol 23: 1203–1210
Banerjee S, Mimouni FB, Mehta R (2003) Lower whole blood ionized magnesium concentrations in hypocalcemic infants of gestational diabetic mothers. Magnes Res 16: 127–130
Stewart AF (2004) Translational implications of the parathyroid calcium receptor. N Engl J Med 351: 324–326
Toke J, Patocs A, Balogh K (2009) Parathyroid hormone-dependent hypercalcemia. Wien Klin Wochenschr 121: 236–245
Schell-Feith EA, Kist-van Holthe JE, van der Heijden AJ (2010) Nephrocalcinosis in preterm neonates. Pediatr Nephrol 25: 221–230
Bachetta J, Harambat Jr, Dubourg L et al (2009) Both extrauerine and intrauterine growth restriction impair renal function in children born very preterm. Kidney International 76: 445–452
Zazzo JF, Troche G, Ruel P Maintenant J (1995) High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function. Intensive Care Med 21: 826–831
Putet G, Rigo J, Salle B, Senterre J (1987) Supplementation of pooled human milk with casein hydrolysate: energy and nitrogen balance and weight gain composition in very low birth weight in¬fants. Pediatr Res 21: 458–461
Fuentebella J, Korner JA (2009) Refeeding syndrome. Ped Clin N Am 56: 1201–1210
Caudarella R, Vescini F, Buffa A, Francucci CM (2007) Hyper- phosphatemia: effects on bone metabolism and cardiovascular risk. J Endocrinol Invest 30 (Suppl 6): 29–34
Rauch F, Schoenau E (2001) The developing bone: Slave or master of its cells and molecules? Pediatr Res 50: 309–314
Rauch F, Schoenau E (2002) Skeletal development in premature infants: A review of bone physiology beyond nutritional aspects. Arch Dis Child Fetal Neonatal Ed 86: F82–F85
Land C, Schoenau E (2008) Fetal and postnatal bone development: reviewing the role of mechanical stimuli and nutrition. Best Pract Res Clin Endocrinol Metab 22: 107–118
Rigo J (2008) Neonatal osteopenia and bone mineralization. eNeonatal Review 6: 4
Bishop N, Sprigg A, Dalton A (2007) Unexplained fractures in infancy: looking for fragile bones. Arch Dis Child 92: 251–256
Harrison CM, Johnson K, McKechnie E (2008) Osteopenia of prematurity: a national survey and review of practice. Acta Paediatrica 97: 407–413
Schulzke SM, Trachsel D, Patole SK (2007) Physical activity programs for promoting bone mineralization and growth in preterm infants. Cochrane Database Syst Rev 18:CD005387
Avila-Díaz M, Flores-Huerta S, Martínez-Muñiz I, Amato D (2001) Increments in whole body bone mineral content associated with weight and length in pre-term and full-term infants during the first 6 months of life. Arch Med Res 32: 288–292
Zamora SA, Belli DC, Rizzoli R et al (2001) Lower femoral neck bone mineral density in prepubertal former preterm girls. Bone 29: 424–427
Fewtrell MS et al (2000) Neonatal factors predicting childhood height in preterm infants: Evidence for a persisting effect of early metabolic bone disease? J Pediatr 137: 668–673
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Rigo, J., Pieltain, C., Viellevoye, R., Bagnoli, F. (2012). Calcium and Phosphorus Homeostasis: Pathophysiology. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Milano. https://doi.org/10.1007/978-88-470-1405-3_49
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DOI: https://doi.org/10.1007/978-88-470-1405-3_49
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