Fractures and metabolic bone disease of the newborn in extremely low birth weight infants: case series and a possible cause

Four preterm babies at 23-26 weeks born with extremely low birth weights. Their weights varied between 390: 760 gm. After resuscitation they were transferred to neonatal intensive care unit [NICU]. They received total parenteral nutrition [TPN] The babies developed hypophosphatemia and normal or hypercalemia. After 3-4 months several bone fractures were discovered. This was attributed to the intended decrease by calcium in TPN in response to the lab finding of normal or high Ca. This in turn leads to further decrease in both serum Ca and P and decreased availability of Ca for bones. Hence, one should think about increasing the phosphorus in the TPN rather than only decreasing Ca in similar cases