Effect of physical activity on bone mineralization in premature infants. Maternal-administered physical activity enhances bone mineral acquisition in premature very low birth weight infants Diet, growth, and bone mineralization in premature infants. Daily Physical Activity Program Increases Bone Mineralization and Growth in Preterm Very Low Birth Weight Infants Early diet of preterm infants and bone mineralization at age five years Rickets in very-low-birth-weight infants born at Baragwanath Hospital. Diet and Bone Mineral Content at Term in Premature Infants Longitudinal study of calcium intake, physical activity, and bone mineral content in infants 6-18 months of age. Longitudinal assessment of growth and bone mineral accretion in prematurely born infants treated for chronic lung disease with dexamethasone. Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term. Increased bone mineral content of preterm infants fed with a nutrient enriched formula after discharge from hospital. Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: a randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge. Randomized, placebo-controlled, calcium supplementation study in pregnant Gambian women: effects on breast-milk calcium concentrations and infant birth weight, growth, and bone mineral accretion in the first year of life. Effect of a calcium and phosphorus-enriched formula on bone mineralization and bone growth in preterm infants after discharge from hospital. Growth and bone mineral status of discharged very low birth weight infants fed different formulas or human milk. Calciuria and aminoaciduria in very low birth weight infants fed a high-mineral premature formula with varying levels of protein. Moderate nutrient supplementation of mother's milk for preterm infants supports adequate bone mass and short-term growth: a randomized, controlled trial. Mineral Homeostasis in Very Low Birth Weight Infants Fed Either Own Mother's Milk or Pooled Pasteurized Preterm Milk Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition. Growth and body composition of preterm infants: influence of nutrient fortification of mother's milk in hospital and breastfeeding post‐hospital discharge Effects of motor physical therapy on bone mineralization in premature infants: a randomized controlled study Growth and bone mineralization in preterm infants fed preterm formula or standard term formula after discharge. Growth and bone mineralization of normal breast-fed infants and the effects of lactation on maternal bone mineral status.
OBJECTIVE A 4-week pilot study was done with 26 preterm infants to evaluate whether a physical activity program would result in greater bone mineralization . DESIGN Subjects were matched by birth weight , gender , and gestational age , and r and omly assigned to the  physical activity program ( group EX ; n = 13 ) or to the  control group  ( group C ; n = 13 ) . Physical activity consisted of range of motion with passive resistance to all extremities for 5 to 10 minutes daily . Baseline and 4-week values were determined for both bone mineral analyses and serum levels of calcium , phosphate , alkaline phosphatase , parathyroid hormone , and 25-hydroxy-vitamin D. RESULTS Despite similar nutrient intake at advised levels for preterm infants , EX infants gained more weight than control subjects ( 17.8 vs 13.4 gm/kg body weight per day ; p = 0.01 ) . A difference in radial bone mass and density change as determined by single-beam photon absorptiometry ( + /- 2 % error ) was found between groups ( p = 0.006 by analysis of covariance ) . Changes in bone width and in bone mineral content and density were enhanced by physical activity . Group EX infants had 12 % , 18 % , and 34 % gains in bone width and in bone mineral density and content , respectively ; group C infants had only a 2 % gain in bone width and 11 % and 14 % losses from baseline in bone mineral content and density , respectively , during the 4-week study . Serum biochemical values were similar in the groups except for lower alkaline phosphatase levels in group EX . There was a negative association between bone mineral content and parathyroid hormone values : r = -0.83 , p = 0.01 . CONCLUSIONS A physical activity program may increase the effects of adequate nutrition in healthy preterm very low birth weight infants by promoting weight gain and bone mass and by decreasing the risk of osteopenia Objective : To determine if physical activity delivered by an infant 's mother would be as effective in promoting bone mineral acquisition in preterm very low birth weight ( VLBW ) infants as the same intervention administered by a trained therapist . Patients and methods : Preterm VLBW infants were r and omized to receive daily physical activity administered by the infant 's mother  ( MOM , n=11 ) or a trained therapist ( OT , n=11 ) , or control ( n=11 ) . Physical activity consisted of range of motion movements against passive resistance to all extremities for 5 to 10 min daily . All infants were fed mother 's milk with fortification to 24 kcal oz−1 . Dual energy x-ray of the forearm bone area ( BA , cm2 ) , mineral content ( BMC , g ) , and density ( BMD , g/cm2 ) and measurement of bone formation ( bone-specific alkaline phosphatase , BAP ) and resorption ( urine pyridinium crosslinks of collagen , Pyd ) were obtained at study entry and at 2.0 kg of body weight . Result : Forearm BA and BMC gains were greater in MOM and OT infants compared to the control infants despite similar postnatal growth rate and nutrient intake . Serum BAP levels decreased in controls but remained unchanged in MOM and OT infants . Urine Pyd levels were similar at baseline to 2.0 kg for all groups . These findings suggest greater bone growth and mineral acquisition in MOM and OT infants than control infants . Conclusion : This study demonstrates that a physical activity program administered by the infant 's own mother is as equally effective as therapist-administered physical activity in promoting greater bone growth and mineral acquisition in preterm VLBW infants Energy , protein , and mineral requirements in premature infants are high , hence increasing the risk of poor growth and development of metabolic bone disease . This double-blind study included 127 consecutive premature infants with gestational age below 32 weeks . Both sick and healthy infants participated . Average duration of ventilator treatment : 2 days , CPAP treatment : 10 days ( range , 0 - 50d ) . Infants were r and omized to 3 groups from 1 week old to 37 weeks of gestational age and fed the following : a ) human milk ( their own mother 's milk or banked milk ) supplemented with phosphate , b ) human milk fortified with protein , calcium , and phosphate , or c ) unsupplemented mother 's milk or preterm formula . Infants r and omized to preterm formula were fed formula only if their own mother 's milk was not available , hence there were 2 subgroups of infants fed either unsupplemented human milk or preterm formula . Volume of intake was 191+/-14mL/kg/d ( mean + /- SD ) ; linear growth was measured weekly by knemometry ; head circumference was measured weekly ; and growth rate was calculated by linear regression for each infant . Bone mineralization and body composition were measured by DEXA-scan ( Hologic 1000/W ) at term . There was a tendency toward slower growth and less bone mineral content in infants fed unsupplemented human milk but , surprisingly , the difference was small and not significant Objective . A study of daily physical activity was performed with 32 preterm infants to evaluate changes in body weight and bone mineralization . Study Design . Subjects were matched by birth weight and gestational age and r and omly assigned to the  physical activity ( PA;n = 16 ) or to the control  ( C ; n= 16 ) program . PA consisted of range of motion against passive resistance to all extremities for 5 to 10 minutes daily . Peripheral dual-energy x-ray of the right forearm ( ulna and radius ) ; biomarkers of bone formation ( serum type I collagen C-terminal propeptide [ PICP ] ) and resorption ( urine pyridinoline cross-links of collagen [ Pyd ] ) ; serum calcium , phosphate , alkaline phosphatase , parathyroid hormone ( PTH ) , and 1,25-(OH)2 vitamin D ; and urine levels of calcium , phosphate , and creatinine were obtained . All measurements were made at study entry and at 2.0 kg of body weight . Results . Despite a similar nutrient intake at advised levels for preterm infants , gains in body weight ( g ) and forearm bone length ( cm ) , bone area ( BA ; cm2 ) , bone mineral content ( BMC ; mg ) , and fat-free mass ( g ) were greater in PA infants . Forearm bone mineral density and fat mass gains did not differ between groups . Serum PICP levels remained constant in PA infants but decreased in C infants suggesting a slower rate of bone formation . Urine Pyd or bone resorption activity was similar between groups . A higher level of serum PTH was observed in PA infants at 2.0 kg of body weight ; however , the change from study entry to completion did not differ between groups . All other serum and urine values were similar and within normal limits . Conclusion . A daily PA program promotes greater gains in body weight , forearm length , BA , BMC , and fat-free mass in premature infants Bone disease with significantly reduced bone mineralization is common in preterm infants , and associated with later linear growth stunting at 18 months of age . Dietary insufficiency of calcium and phosphorus is thought to be the principal aetiological factor . We studied 54 children at mean age 5 years who were born preterm and had participated in a prospect i ve multicentre study of effects of early diet on later growth and development . Diets compared were banked donor breast milk and preterm formula fed as a supplement to mother 's own milk . Increasing human milk intake was strongly positively associated with later bone mineral content . Children fed predominantly human milk had greater bone mineral content than children of similar size born at term . These data suggest that the early nutritional environment of the preterm infant could play an important role in determining later skeletal growth and mineralization Disturbed mineral and bone metabolism has been reported to occur frequently in very-low-birth-weight infants fed breast-milk during the first 3 months of life . This study was design ed to assess the prevalence of disturbed mineral homeostasis in a breast-milk-fed very-low-birth-weight population at Baragwanath Hospital and to determine whether the addition of a preterm infant formula to the feeds would reduce this prevalence and increase the rate of weight gain .  Fifty-three neonates weighing less than 1 200 g at birth were monitored for weight gain , growth and biochemical and radiological evidence of metabolic bone disease at 2-weekly intervals during hospitalisation and for 18 weeks after discharge . The infants were r and omised at 2 weeks of age to receive either breast-milk only , or a combination of breast-milk and a premature formula containing 550 mg calcium and 300 mg phosphorus . All infants received 800 IU vitamin D daily from day 14 . Weight gain and growth were similar in both groups . Calcium and phosphorus intakes were higher in the mixed feeding group , but did not affect serum mineral levels . Radiological rickets was uncommon in both groups although periosteal reactions and osteopenia occurred frequently and with similar prevalences . Vitamin D deficiency was not found to be a problem . In conclusion , overt rickets is not a major problem in very-low-birth-weight infants born at Baragwanath Hospital , although biochemical abnormalities occur frequently . ( ABSTRACT TRUNCATED AT 250 WORDS Premature infants are at risk of developing metabolic bone disease mainly because of low calcium and phosphorus intake . We have examined the effect of different mineral supplements on bone mineral content at term in 127 premature infants with gestational age < 32 wk in a double-blinded r and omized trial . We used either phosphate supplementation of human milk as recommended by the European Society of Pediatric Gastroenterology and Nutrition or fortified supplementation with protein , calcium , and phosphorus or preterm formula as recommended by the American Academy of Pediatrics . The intervention period was from 1 week old until 36 wk of gestational age , and the infants were fed approximately 200 mL·kg−1·d−1 . Bone mineral content was measured at term by dual-energy x-ray absorptiometry scan . Surprisingly , neither phosphate , fortifier , nor preterm formula supplementation had any significant effect on bone mineral content at term compared with infants fed their own mother 's milk only . There was a tendency to higher total bone mineral content in infants fed preterm formula compared with infants fed their own mother 's milk only ( p = 0.05 ) , but when the bone mineral content was corrected for the size of the infant , there was no difference ( p = 0.68 ) . Infants fed preterm formula had a significantly higher weight at term compared with infants fed their own mother 's milk only ( p = 0.02 ) , but did not differ significantly in length or head circumference . In a regression analysis , the amount of supplemented phosphorus was significantly associated with weight at term ( p = 0.008 ) . We conclude that when feeding 200 mL·kg−1·d−1 , mineral supplementation of human milk or use of preterm formula does not significantly improve bone mineralization outcome at term Although increased physical activity early in life is recommended for optimizing bone health , no controlled trials on the effect of activity on bone mass accretion during periods of rapid growth have been reported . The purpose of this study was to determine whether infants r and omized to a 1 year gross motor activity program  had a greater bone mass accretion than infants r and omized to a fine motor activity program .  The gross motor program included activities that focused on loading the skeleton and were performed for 15 - 20 minutes/day , 5 days/week by study personnel . Infants ( n = 72 ) were enrolled at 6 months of age , and total body bone mineral content ( BMC ) , 3-day diet records , and activity levels were obtained at 6 , 9 , 12 , 15 , and 18 months . BMC was associated with weight , length , and bone area at all ages and correlated with earlier calcium intakes . Calcium intake appeared to modify the effect of  gross motor activity  on bone mass accretion ; infants in both groups had similar bone accretion at moderately high calcium intakes , but at low calcium intakes infants in the gross motor program had less bone accretion than infants in the fine motor program . Compliant infants in the gross motor group had lower BMC at 18 months compared with noncompliant infants . These results indicate that BMC in infants is related to calcium intake , and we speculate that participation in a gross motor program during rapid bone growth may lead to reduced bone accretion in the presence of a moderate to moderately low calcium intake The objective of this study in premature infants was to assess the relationship between  dexamethasone  , growth and bone mineral accretion .  Nine appropriate size for gestational age premature infants treated for chronic lung disease with tapering doses of dexamethasone ( 0.5 - 0.1 mg/kg/day over 37 + /- 7 days ) were individually matched to a comparison infant by sex , gestational age , birth-weight , and type of feed . Infant growth and bone mineral accretion were measured at equivalent gestational ages from recruitment until 6 months corrected age . During hospitalization , mean rate of weight , length and head circumference growth and bone mineral accretion in the distal radius were significantly lower in the dexamethasone-treated infants in spite of similar nutrient intakes . Dexamethasone infants had significantly lower plasma phosphorus , and urinary calcium , pyridinoline and N-telopeptide excretion .  Dexamethasone affected absolute length , but not weight , throughout the study . No significant differences were observed in body composition or absolute radial and whole body bone mineral content . The results indicate that dexamethasone therapy compromises growth and bone mineral accretion in small premature infants .  ' Catch-up ' linear growth was not evident at 6 months of age and reflects the importance of early nutrition interventions BACKGROUND Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking , recommendations for the mineral content of preterm infant formula differ greatly between committees . OBJECTIVE The goal of the study was to assess the effects of an isocaloric , nutrient-enriched preterm formula , which was fed from the age when full enteral feedings were tolerated through expected term , on bone mineralization in preterm infants . DESIGN We conducted a prospect i ve , r and omized , double-blind study in healthy , preterm infants ( gestational age of 28 - 32 wk ) who were fed either a control preterm formula ( n=20 ) or an isocaloric , nutrient-enriched preterm formula ( n=21 ) until 3 mo of age ( ie , approximate expected term ) .  Serum calcium indexes were taken throughout the study , and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term . RESULTS A total of 37 infants ( experimental formula , n=19 ; control formula , n=18 ) completed the study . Compared with control subjects , infants fed the experimental formula had 25 % and 40 % higher intakes of calcium and phosphorus , respectively . Serum calcium , phosphorus , osteocalcin , and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point . The bone mineral content of infants fed the experimental formula was 23 % ( P=0.039 ) and 35 % ( P=0.002 ) higher at hospital discharge and expected term , respectively . CONCLUSIONS Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric , nutrient-enriched formula than in those fed control formula . Continuation of the experimental formula beyond hospital discharge , through expected term , further improved bone mineralization Bone disease with persistent reduced bone mineralisation is common in premature infants . To test the hypothesis that enhancement of nutritional intake after discharge from hospital improves bone mineralisation , 31 formula fed preterm infants were r and omly assigned to receive st and ard or multinutrient enriched milk from the time of discharge . The calcium and phosphorus contents of the enriched milk were 70 and 35 mg/100 ml v 35 and 29 mg/100 ml for the st and ard formula . Bone mineral content was measured before discharge from hospital in 21 of the infants ; there was no difference in the bone mineral content between the groups at that time ( 35 mg/cm for the two groups ) . There was a significant increase in bone mineral content for those infants receiving the enriched v st and ard formula at 3 and 9 months corrected postnatal age : at 3 months the bone mineral content was 83 v 63 mg/cm and at 9 months 115 v 95 mg/cm . The difference between the groups was thus maintained although not increased at a corrected age of 9 months , when the bone mineral content of infants fed the enriched but not the st and ard formula was no longer significantly different from that of normal infants after adjusting for body size . The difference was not explained by the larger body size in infants fed the enriched formula . The results suggest that the use of a special nutrient enriched postdischarge formula has a significant positive effect on bone growth and mineralisation during a period of rapid skeletal development OBJECTIVES ( 1 ) To determine whether nutrient malabsorption or inadequate nutrient intake were involved in the cause of growth delay in patients with bronchopulmonary dysplasia , and ( 2 ) to determine whether a nutrient-enriched formula given to infants with bronchopulmonary dysplasia to 3 months corrected age improves the rate of growth with greater lean and bone mass accretion when compared with infants fed an isoenergetic st and ard infant formula . STUDY DESIGN A blinded , nutrition intervention trial of 60 preterm infants with bronchopulmonary dysplasia ( birth weight , 866 + /- 169 g , gestational age , 26 + /- 1.5 weeks ) r and omized to either nutrient-enriched formula or st and ard formula .  Growth , body composition , and nutrient retention were compared between groups by Student 's t tests and analysis of covariance . RESULTS Infants fed the enriched formula had significantly greater nitrogen and mineral retention at 38 weeks ' postmenstrual age , and only the infants fed enriched formula had zinc retention similar to the intrauterine accretion . At 3 months corrected age infants fed enriched formula attained greater length ( P < .05 ) , greater radial bone mineral content ( P < .01 ) , and greater lean mass ( P < .01 ) . The male infants in the enriched formula group had greater whole body bone mineral content than did male infants in the st and ard formula group ( P = .02 ) . CONCLUSIONS Greater linear growth and lean and bone mass in the enriched formula group suggests that infants with bronchopulmonary dysplasia attain faster " catch-up " growth when fed higher intakes of protein , calcium , phosphorus , and zinc than provided in st and ard proprietary formulas BACKGROUND Growth and bone mineral accretion in Gambian infants are poorer than those in Western population s. The calcium intake of Gambian women is low , typically 300 - 400 mg Ca/d , and they have low breast-milk calcium concentrations , which result in low calcium intakes for their breastfed infants . A low maternal calcium supply in pregnancy may limit fetal mineral accretion and breast-milk calcium concentrations and thereby affect infant growth and bone mineral accretion . OBJECTIVE We investigated the effects of calcium supplementation in Gambian women during pregnancy on breast-milk calcium concentrations and infant birth weight , growth , and bone mineral accretion . DESIGN A r and omized , double-blind , placebo-controlled supplementation study was conducted in 125 Gambian women who received 1500 mg Ca/d ( as calcium carbonate ) or placebo from 20 wk of gestation until delivery . Infant birth weight and gestational age were recorded . Breast milk was collected , and infant anthropometric and bone measurements were performed at 2 , 13 , and 52 wk after delivery . Infant bone mineral status was assessed by using single-photon absorptiometry of the radius and whole-body dual-energy X-ray absorptiometry . RESULTS Compliance with the supplement was high . No significant differences were detected between the groups in breast-milk calcium concentration , infant birth weight , or growth or bone mineral status during the first year of life . A slower rate of increase in infant whole-body bone mineral content and bone area was found in the supplement group than in the placebo group ( group x time interaction : P = 0.03 and 0.02 , respectively ) . CONCLUSION Calcium supplementation of pregnant Gambian women had no significant benefit for breast-milk calcium concentrations or infant birth weight , growth , or bone mineral status in the first year of life At discharge from hospital , 36 preterm infants ( birthweight < 1,800 g ) were r and omized to be given either a st and ard formula or an identical formula enriched with calcium ( 47 vs. 80 mg/100 ml ) and phosphorus ( 30 vs. 45 mg/100 ml ) exclusively until they reached a corrected age of 3 months , thereafter beikost and other formulas were introduced into the diet . Weight , head circumference and radial and body length were measured and radial bone mineral content ( BMC ) and bone width ( BW ) determined by single photon absorptiometry at discharge , at 3 and at 6 months of corrected age . Additionally , an X-ray of the wrist was taken and serum alkaline phosphatase activity determined at discharge , and the latter repeated at 3 months . Bone mineral content , bone width , and the individual increments of both parameters were significantly higher in infants fed the enriched formula at 3 months of age , but these differences were less pronounced at 6 months The objective of this study was to determine whether the growth and bone mineral status of discharged preterm infants fed human milk  differed from those of infants fed one of three different formulas varying in calcium content ( 545 mg/L , 660 mg/L , or 1290 mg/L ) . A r and omized , blinded study was conducted for 16 weeks after discharge in 16 human milk-fed and 43 formula-fed infants . All formula-fed infants received one of the three study formulas from discharge to 8 weeks afterward , and the st and ard formula , which contained 545 mg/L calcium , from 8 to 16 weeks . The human milk-fed infants gained weight more slowly than the formula-fed infants . The human milk-fed infants also had lower gains in length and higher serum alkaline phosphatase values than the formula-fed infants . The infants who received the formula containing the highest calcium concentration ( 1290 mg/L ) had greater bone mineral density during the first 8 weeks of the study . We conclude that preterm infants recently discharged from the hospital may benefit from higher calcium intake than is provided by either human milk or st and ard term formula To assess the influence of protein intake on renal excretion of calcium and amino acids and on bone mineralization in preterm infants , we r and omly selected within weight group strata 27 infants who weighed < 1500 gm at birth ( nine per group ) to be fed a high-mineral ( calcium , 940 mg/L ; phosphorus , 470 mg/L ) premature formula with one of the following protein contents : formula A , 3.0 gm/100 kcal ; formula B , 2.7 gm/100 kcal ; and formula C , 2.2 gm/100 kcal . Mean ( + /- SD ) daily weight gain was greater in infants receiving the higher protein intakes for the first 30 days ( formula A , 24.8 + /- 5.1 gm ; formula B , 20.5 + /- 3.8 gm ; formula C , 16.2 + /- 5.9 gm ( analysis of variance : p < 0.01 ; C < A , p < 0.05 ) ) . Bone mineral content did not differ at any time point , and all groups had a high prevalence of generalized aminoaciduria ( 4 weeks : formula A , 56 % ; formula B , 71 % ; formula C , 75 % ) . Urinary calcium corrected for creatinine ( in milligrams per milligram ) increased as protein content decreased ( 2 weeks : formula A , 0.16 + /- 0.10 ; formula B , 0.20 + /- 013 ; formula C , 0.44 + /- 0.33 ( C > A , C > B , p < 0.05 ) ; 4 weeks : formula A , 0.23 + /- 0.15 ; formula B,0.34 + /- 0.47 ; formula C , 0.49 + /- 0.22 ( C > A , p < 0.01 ) . We conclude that the high mineral content and other components of premature formulas result in a higher growth rate and may increase protein requirements . Failure to meet protein requirements may result in underutilization of absorbed calcium and increased renal excretion of calcium . In preterm infants , higher protein intake probably supports rather than jeopardizes bone mineral accretion , and reduces rather then increases calciuria Our objectives were 1 ) to determine whether moderate nutrient supplementation of mother 's milk ( MM ) for preterm infants , in the form of a new multinutrient fortifier ( MNF ) , would improve short-term growth and bone mineral content ( BMC ) when compared with supplementation with calcium and phosphorus alone ; and 2 ) to investigate whether moderate calcium and phosphorus intakes , in the form of calcium glycerophosphate ( CaGP ) , result ed in a BMC similar to that of term corrected infants . Twenty-five preterm infants fed MM were r and omly assigned to receive either MM+MNF or MM+CaGP . A third group of infants fed preterm formula ( PTF ) served as a comparison group . Whole-body BMC and lean and fat mass were determined by dual-energy X-ray absorptiometry ( DXA ) at full-term age . Nitrogen retention and calcium , phosphorus , and zinc intakes were determined by using mass balance techniques . Nitrogen retention was significantly lower in the MM+CaGP group than in the PTF group as were both weight and length gain ( weight gain : 16.6 + /- 1.6 , 14.2 + /- 2.0 , and 16.1 + /- 2.9 g x kg(-1 ) x d(-1 ) ; length gain : 1.1 + /- 0.2 , 0.9 + /- 0.2 , and 1.1 + /- 0.3 cm/wk for the MM+MNF , MM+CaGP , and PTF groups , respectively ) . Biochemical indexes of mineral status and bone turnover were normal . Conservative amounts of calcium and phosphorus , as CaGP , result ed in adequate BMC . Moderate amounts of protein , calcium , and phosphorus plus trace elements added to MM in the form of an MNF result ed in improved linear growth but did not provide any advantages to BMC when compared with supplementation with calcium and phosphorus alone Summary : As part of a r and omised controlled study to assess the effect of pasteurization of breast milk on the growth of very‐low‐birth‐weight infants , the longitudinal changes in serum calcium , phosphorus , alkaline phosphatase , 25‐hydroxyvitamin D , and bone‐gla‐protein concentrations were investigated . Infants fed untreated own mother 's milk grew more rapidly than those fed pasteurized pooled preterm milk and had higher serum alkaline phosphatase and lower phosphorus values . Serum calcium and 25‐hydroxyvitamin D ( 25‐OHD ) concentrations were similar in the two groups . Despite the provision of 750 IU vitamin D daily from the 2nd week of life , serum 25‐OHD values remained low in a number of infants in both groups , suggesting that either malabsorption of vitamin D or hepatic immaturity might be responsible for the persistently low values . Bone‐gla‐protein rose significantly after birth and was correlated with alkaline phosphatase values , but not with 25‐OHD or phosphorus values . The study supports previous work that indicates that the low phosphorus content of breast milk is probably responsible for biochemical evidence of inadequate bone mineralization and that despite vitamin D supplementation , 25‐OHD values do not rise adequately . Thirty‐six infants were reexamined between 4 and 11 months after birth . The 25‐OHD values had risen significantly in all infants except one who had vitamin D deficiency rickets BACKGROUND Despite the theoretical benefits of nutrient-enriched formula given to preterm infants after hospital discharge , its role in reversing growth deficits after hospital discharge remains poorly defined . OBJECTIVE The aim was to determine the effect of different formulas on the growth , bone mass , and body composition of preterm infants after hospital discharge . DESIGN This was a r and omized , double blind comparison of a nutrient-enriched formula ( EF ) and a formula for term infants ( TF ) given for 1 y after hospital discharge . Compared with the TF , the EF had a higher energy density and higher contents of protein , calcium , and phosphorus ( by 10 % , 21 % , 44 % , and 11 % , respectively ) and higher contents of almost all other nutrients ( by > or=10 % ) . RESULTS  Birth weights of the infants were 630 - 1620 g ( median : 1250 g ) and gestational ages were 24 - 34 wk ( median : 29 wk ) . TF result ed in significantly greater weight , length , head circumference measurements , and their respective z scores on the basis of age- and sex-specific norms . At the end of the study , the mean z scores for the corrected age of infants in the TF group were -0.37 for weight , 0.001 for length , and 0.50 for head circumference . The TF group also had significantly greater dual-energy X-ray absorptiometry measured bone and lean and fat mass than did the EF group ( P < 0.05 for all comparisons ) . CONCLUSIONS The use of EF for preterm infants after hospital discharge shows no advantage over TF in growth , bone mineralization , and body composition . More studies are needed to determine the optimal postdischarge nutrition support for preterm infants We examined the influence of multi‐nutrient fortification of mother 's milk ( MM + MNF ) compared to supplementation with calcium and phosphorus ( MM + CaGP ) alone in hospital ( in a r and omized trial ) , and of breastfeeding ( post‐MM ) compared to formula feeding ( post‐FF ) after hospital discharge with a descriptive analysis of growth and body composition to 1 y corrected age in preterm infants .  Anthropometry , nutrient intakes and whole body bone mineral content , lean and fat mass were determined at four time points in the first year after term corrected age . Body composition was determined with dual energy X‐ray absorptiometry . MM + MNF compared to MM + CaGP for preterm infants in the early neonatal period did not appear to influence growth or body composition in the first year . Growth in post‐MM and post‐FF groups was within the normal range of growth references derived from term infants fed mother 's milk . Post‐MM infants had lower whole body bone mineral content ( 132.3 ± 10.4 g ) at 6 months corrected age when compared to post‐FF infants ( 159.4 ± 14.1 g ) and greater percent fat mass to 12 months corrected age . These differences may result from the lower calcium , phosphorus and protein intakes in post‐MM compared to post‐FF infants . Our findings demonstrate that dietary practice s after hospital discharge likely have a greater impact on body composition in prematurely born infants than dietary practice s in hospital . Whether the observed differences in body composition between breastfed and formula‐fed preterm infants have any long‐term consequences requires further investigation Objective : To study the effect of physical therapy on bone mineralization , weight gain and growth in preterm infants . Method : After fulfilling the inclusion criteria , preterm infants were matched for gestational age and birth weight and then r and omly assigned to the physiotherapy group ( PG , n=15 ) and control group ( CG , n=14 ) . The PG received motor physical therapy for 15 min daily , 5 times per week until hospital discharge . Bone mineralization was measured by total body dual energy X-ray beam absorptiometry ( DEXA ) at the onset and end of the study . Statistical analysis was realized by ANCOVA and linear correlation tests . Result : The physical therapy group ( PG ) presented greater body weight gain per day ( 27.4±2.4 vs 21.01±4.4 g , P<0.001 ) and length ( 1.3±0.3 vs 0.8±0.2 cm week−1 , P<0.001 ) than did the control group ( CG ) . Body composition values verified by DEXA were greater for the PG . The mean gain in bone mineral content ( BMC ) ( mg ) was greater in the PG ( 434±247.5 vs −8.9±11.4 , P<0.001 ) , as was the mean bone mineral density ( BMD ) gain ( mg cm−2 ) ( 8.4±5.6 vs −3.1±5.5 , P<0.001 ) . The gain in bone area ( BA , cm2 ) was 10.3±5 in the PG vs 1.5 ±2 in the CG ( P<0.001 ) . The gain in lean mass ( LM ) ( g ) in the PG was also greater than in the CG ( 271.1±21.4 vs 109.1±1.0 , P<0.009 ) . The fat mass ( g ) was similar between the groups ( P=0.432 ) . Conclusion : These results showed that physiotherapy in preterm infants  produced greater gains in growth , body weight , BMC , BMD , BA and LM OBJECTIVE To evaluate growth and bone mineralization in very low birth weight ( VLBW ) infants fed preterm formula ( PF ) or term formula ( TF ) . STUDY DESIGN In a double-blind prospect i ve study , 49 preterm infants of gestational age 33 weeks or less were r and omly fed  PF or TF  for 2 months after discharge , then all of the infants were fed TF for the next 2 months . Anthropometric and dual-energy x-ray absorptiometry data were collected at discharge and at 2 months and 4 months after discharge . Anthropometric data also were collected at 12 months postterm . RESULTS Four months after discharge , both body weight ( 6139 + /- 1254 g vs 5540 + /- 863 g ; P = .03 ) and bone mineral content ( 104.4 + /- 29.2 g vs 87.5 + /- 17.1 g ; P = .01 ) were significantly higher in the PF group compared with the TF group . At 12 months postterm , mean body weight , length , and head circumference remained higher in the PF group than in the TF group , and body mass index was similar and within the normal range in the 2 groups . CONCLUSIONS At 4 months after discharge , growth and mineralization were better in the VLBW infants who were fed PF during the first 2 months after discharge compared with those who were fed TF , suggesting that PF may be particularly valuable at this early stage of development To determine if human milk provides for adequate growth and bone mineralization during the lst yr of life , 91 term infants were evaluated . Infants were divided into three groups human milk alone , human milk with supplemental vitamin D , and Similac .  Lactating mothers who were receiving supplements of calcium and vitamin D  were also studied to determine the effects of lactation on their bone mineral status . Blood was drawn from infants and mothers for measurements of serum calcium , phosphate , alkaline phosphatase , and 25-hydroxyvitamin D. Bone mineral content was measured by photon absorptiometry . Growth was similar between breast-fed and formula-fed infants . Regardless of type of feeding , male infants grew heavier and longer than corresponding female infants . Serum calcium and phosphate levels were similar among the three infant groups : only 25-hydroxyvitamin D levels at 4 months and serum alkaline phosphatase at 2 wk and 6 months of age were different among the three infant groups . Biochemical and vitamin D values were similar among the lactating mothers . There were no differences in infant bone mineral content among the three groups , but male infants had higher bone mineral content than female infants . There were no effects of the duration of lactation of maternal bone mineral content or vitamin D status
Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants .
Current evidence does not support the routine use of physical activity programs in preterm infants .
BACKGROUND Lack of physical stimulation may contribute to metabolic bone disease of preterm infants , result ing in poor bone mineralization and growth .
Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth .
OBJECTIVES The primary objective was to assess whether physical activity programs in preterm infants  improve bone mineralization and growth and reduce the risk of fracture .
Subgroup analysis : • Given that the smallest infants are most vulnerable for developing osteopenia ( Bishop 1999 ) , a subgroup analysis was planned for infants with birth weight < 1000 g.•  Calcium and phosphorus intake may affect an infant 's ability to increase bone mineral content ( Kuschel 2004 ) .