Jean J. Steichen

Osteopenia of prematurity: The cause and possible treatment+

By photon absorptiometry, extrauterine bone mineralization in low-birth-weight infants fed a standard commercial formula lags significantly behind intrauterine bone mineralization. In the present study, infants of 28- to 32-week and 33- to 35-week gestational age were studied. The calcium content in a standard formula was increased to provide a daily calcium intake of 220 to 250 mg/kg/day. Phosphate intake was 110 to 125 mg/kg/day. Extrauterine bone mineralization by photon absorptiometry appeared to approximate the intrauterine bone mineralization rate.

Bone mineral content and serum 25-hydroxyvitamin D concentrations in breast-fed infants with and without supplemental vitamin D: One-year follow-up

in association with hypothyroidism. We did not obtain parietal cell or intrinsic factor antibodies. There was no evidence of other au to immune diseases or deficiencies in the mother (or int2ant) on the basis of routine clinical and laboratory tests. Breast-fed infants are at risk for nutr i t ional deficiencies if the mother is malnourished, a vegan, or if she has an abnormali ty in nut r ien t metabolism. Physicians should be aware tha t even with a well-balanced mate rna l diet, an occasional breast-fed infant can develop a serious nutritional deficiency.

Bone mineralization and growth in term infants fed soy-based or cow milk-based formula

The purpose of this study was to evaluate the adequacy of a soy protein-based formula versus a cow milk protein-based formula for body growth and skeletal mineralization in the first year of life. Thirty-six healthy, term, appropriate for gestational age infants were assigned randomly and prospectively to one of two feeding groups and observed longitudinally over the first year of life. Group 1 infants (n = 18) were fed soy protein isolate-based formula (Isomil with Iron); group 2 infants (n = 17) were fed a cow milk protein-based formula (Similac with Iron). All infants were given the formula within the first 24 hours of life, and were fed the study formula through the first year of life. Weight, length, and head circumference were recorded; bone mineral content (BMC) and bone width (BW) were measured at one-third distal length (midshaft) of the left radius and ulna during the first 18 days of life, and again at 6 weeks, and 3, 6, 9, and 12 months postnatally. Baby food was provided to all infants, and except for type of formula, food intake was similar for all infants. Weight, length, and head circumference were normal in all infants and not different between groups. BMC and BMC/BW were similar for both groups at entry into the study. Group 1 infants had significantly lower BMC and BMC/BW at 3, 6, 9, and 12 months of age (P less than 0.05 to P less than 0.0001) compared with group 2 infants, but their values were similar to those in previously studied infants receiving human milk with vitamin D supplementation. The long-term implication of differences in bone mineralization in early infancy for long-term skeletal mineralization remains to be determined.

Bone mineral content and serum 25-hydroxyvitamin D concentration in breast-fed infants with and without supplemental vitamin D

Eighteen term, healthy, appropriate for gestational age, breast-fed infants were studied in a double-blind prospective study to determine whether or not supplemental vitamin D affected bone mineralization. All patients were from a single, private pediatric practice. Nine infants were randomly assigned to a vitamin D supplement of 400 IU/day and nine infants to a placebo. By 12 weeks of age, infants receiving placebo had a significant decrease in bone mineralization and in serum 25-hydroxyvitamin D concentrations compared to the vitamin D-supplemented group. It is not known whether or not the increased BMC at 12 weeks of age in vitamin D-supplemented breast-fed infants is of ultimate value. Supplemental vitamin D may be necessary for optimal bone mineralization in term breast-fed infants. A longer follow-up study and additional analyses are required to make conclusive statements.

Elevated serum 1,25 dihydroxyvitamin D concentrations in rickets of very low-birth-weight infants.

Elevated 1,25 dihydroxyvitamin D concentrations were found in five VLBW infants who developed rickets at two to three months postnatal age or term postconceptual age; 25 hydroxyvitamin D concentrations were low. Bone mineralization was found to be extremely low as measured by infant-adapted direct photon absorptiometry. After treatment with a formula supplemented with additional Ca and P, there was a rapid improvement in bone mineralization with a concomitant decrease of 1,25(OH)2D to normal adult values, whereas 250HD values increased and parathyroid hormone values decreased. In the VLBW infants studied, we suggest that rickets may be caused by Ca and P deficiency rather than by a deficiency of vitamin D metabolism.

Increasing serum calcium and magnesium concentrations in breast-fed infants: Longitudinal studies of minerals in human milk and in sera of nursing mothers and their infants

Longitudinal calcium, magnesium, and phosphorus concentrations were measured in human milk and in the sera of 18 nursing mothers and their infants over a six-month period. During this time, progressive increases in serum calcium and magnesium concentrations were observed in breast-fed infants, in association with a decreasing phosphorus content of breast milk. Maternal serum calcium and magnesium concentrations also increased during this period. It is speculated that the physiologic rise in serum calcium and magnesium concentrations in exclusively breast-fed infants may be partly accounted for by a decrease in dietary phosphorus intake.

Bone mineral content measurement in small infants by single-photon absorptiometry: Current methodologic issues

Single-photon absorptiometry (SPA), developed in 1963 and adapted for infants by Steichen et al. in 1976, is an important tool to quantitate bone mineralization in infants. Studies of infants in which SPA was used include studies of fetal bone mineralization and postnatal bone mineralization in very low birth weight infants. The SPA technique has also been used as a research tool to investigate longitudinal bone mineralization and to study the effect of nutrition and disease processes such as rickets or osteopenia of prematurity. At present, it has little direct clinical application for diagnosing bone disease in single patients. The bones most often used to measure bone mineral content (BMC) are the radius, the ulna, and, less often, the humerus. The radius appears to be preferred as a suitable bone to measure BMC in infants. It is easily accessible; anatomic reference points are easily palpated and have a constant relationship to the radial mid-shaft site; soft tissue does not affect either palpation of anatomic reference points or BMC quantitation in vivo. The peripheral location of the radius minimizes body radiation exposure. Trabecular and cortical bone can be measured separately. Extensive background studies exist on radial BMC in small infants. Most important, the radius has a relatively long zone of constant BMC. Finally, SPA for BMC in the radius has a high degree of precision and accuracy.

Febrile illness in early infancy associated with ECHO virus infection

Twenty-three infants less than six weeks of age with fever of 100.4 degrees F, or higher and no evidence of bacterial infection were seen at the Cincinnati General Hospital from July to December, 1971. Seventeen of these were admitted to the hospital; 15 were treated with penicillin and kanamycin for possible sepsis. Viral isolation was attempted on 21 of these infants, and ECHO viruses were isolated from 14 (66.7 per cent), compared to three (14.3 per cent) of 21 controls. Eleven of the 14 ECHO viruses isolated were type 4, and the other 3 were types 6, 11, and 25 respectively. Acute and convalescent serum was obtained from 11 of the 21 infants; seven had a fourfold rise in antibody to ECHO virus type 4. Most of the children had fever with irritability, six of the 23 had a fine maculopapular rash, and three had aseptic meningitis. This study suggests that ECHO viruses may be a significant cause of febrile illness in young infants during the summer and fall and may account for illnesses which lead to hospitalization as possible sepsis.

Pediatric Parathyroid Disorders

Recently, advances have been made in the understanding of the interrelationship of parathyroid hormone, vitamin D, and calcitonin. The classic forms of parathyroid disorders in children and their physiologic bases are presented in light of these recent break-throughs in investigation.

Ionized Ca in neonates in relation to gestational age.

GESTATIONAL AGE has been shown to be significantly related to serum calcium levels in the neonate? -3 However, most of the studies have been based on measurements of total calcium concentrations in serum. Since ionized Ca is the important physiologic fraction of Ca in blood, its measurement theoretically should be of greater significance than that of total Ca. Methodologic improvements in ion-specific electrodes have allowed better quantitation of ionized Ca in serum. The present study was designed to analyze the relation of gestational age to iCa levels in the serum of neonates.