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Preterm infants are more prone to bone mineral deficiency the lower their birth weight. To achieve the intrauterine bone mineral accretion rate postnatally, 74 low-birth-weight infants (median birth weight, 980 g; range 430-1.580 g) were each supplemented enterally and/or parenterally with calcium and/or phosphorus in gradually increased amounts. The aim was to yield a simultaneous urinary excretion of Ca and inorganic phosphorus (Pi) at low concentrations (1-2 mmol/L) in spot urine specimens taken twice weekly. The hypothesis was that the intrauterine mineralization rate (4.5 mg cm-1/100 g weight gain) would be achieved postnatally in very low-birth-weight infants, if they were supplemented with enough Ca and/or Pi to effect at least a low (1-2 mmol/L) simultaneous urinary excretion of both ions, as compared with infants who do not excrete both ions and would accrete the bone minerals at a lower rate. The change in bone mineral content was measured by single photonabsorption densitometry and related to weight gain during periods of 2 to 6 wk. Infants who simultaneously excreted Ca (&gt; 1.2 mmol/L) + Pi (&gt; 0.4 mmol/L) in more than half of the urine samples retrospectively showed the highest bone mineral accretion, 5.1 mg cm-1/100 g weight gain, which was equivalent to the fetal mineralization rate (4.5). In this group the bone mineral status significantly contributed to the variance of the bone mineral accretion rate; severely demineralized infants showed a catch-up mineralization. A significantly lower rate (2.4) was observed in infants who excreted Ca+Pi in less than half of the urinary samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of Postnatal Bone Demineralization in Very Low-Birth-Weight Infants by Individually Monitored Supplementation with Calcium and Phosphorus