Abstract
Breast milk has been the universal standard of infant nutrition; the appropriateness of this in the very small infant has been recently questioned. A case of hypophosphatemic rickets in a 595 gm premature will be presented. The infant was begun on breast milk at 12 d. of age and nourished solely on breast milk until diagnosed at 5 mos. at which time x-rays showed marked rachitic changes and fractures in the long bones. Hyper-parathyroidism, Vit D deficiency, dependency and resistence, copper deficiency and inadequate Ca intake were excluded as etiologies. Inorganic phosphate content of maternal milk was normal. At time of diagnosis the pt. was hypercalcemic, hypercalcuric (3.2 gm Ca/gm Cr.), hypophosphatemia (1.6 mg/dl) and had normal alk phos. The tubular reabsorption of phosphate was > 99%.
The hypercalcemia, hypercalcuria and hypophosphatemia conrected and the radiologic changes resolved with phosphate supplementation.
This is the first reported case of hypophosphatemic rickets in a premature fed breast milk. We propose it has not been seen in infants fed proprietary formula because these have from 3 to 7 times as much inorganic phosphate as breast milk. With increased emphasis placed on feeding breast milk to small prematures this condition may become more common unless anticipated.
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Rowe, J., Wood, D., Rowe, D. et al. 463 HYPOPHOSPHATBMIC RICKETS IN BREAST MILK FED PREMATURE. Pediatr Res 12 (Suppl 4), 441 (1978). https://doi.org/10.1203/00006450-197804001-00468
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DOI: https://doi.org/10.1203/00006450-197804001-00468