Interventional nutritional protocol decreases osteopenia of prematurity in extremely low birth weight infants

I. S.I. Mohamed, N. Garrison, R. J. Wynn, Satyanarayana Lakshminrusimha, R. M. Ryan

Research output: Contribution to journalArticlepeer-review


Background: Osteopenia of prematurity is common among extremely low birth weight infants (ELBW). There are currently no standard practices regarding screening, prevention or treatment of this condition. Objective: To determine if introduction of a nutritional monitoring and interventional protocol would decrease the incidence and severity of osteopenia of prematurity. Methods: A nutritional protocol to monitor the needs and provide supplementation of calcium and phosphorus has been instituted in our unit. We compared ELBW infants born in the year before (Group 1) vs. after (Group 2) for lowest serum phosphorus, peak alkaline phosphatase and bone fractures. Logistic regression analysis was used to determine the independent effect of gestational age, birth weight, diuretics, postnatal steroids, and the nutritional protocol. Results: Osteopenia-related outcomes improved, including: phosphorus level <3 mg/dL (34% vs. 14%, (P = 0.003)), peak alkaline phosphatase >750 IU/L (18% vs. 7%, (P = 0.018)), and bone fractures (16.4% vs. 5.4%, (P = 0.026)). The use of diuretics increased significantly, while the use of postnatal steroids decreased significantly. Logistic regression analysis confirmed the independent contribution of our nutritional protocol as well as birth weight to osteopenia of prematurity outcomes. Conclusions: This is the first study to report that initiation of a protocol for monitoring and optimizing bone mineralization can decrease the incidence of severe osteopenia of prematurity as manifested by hypophosphatemia, elevated ALP and bone fractures. Implementation of a neonatal intensive care clinical practice guideline will improve this largely preventable medical complication.

Original languageEnglish (US)
Pages (from-to)33-40
Number of pages8
JournalJournal of Neonatal-Perinatal Medicine
Issue number1
StatePublished - Apr 23 2012
Externally publishedYes


  • extremely low birth weight infants
  • neonatal intensive care
  • nutritional intervention
  • Osteopenia of prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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