During the last 3 months of pregnancy, large amounts of Ca and P are transferred from the mother to the baby for bone growth. If your baby was born prematurely, he or she may not receive the required amounts of Ca and P to properly form strong bones. Despite being fed breast milk with supplements or the use of special formulas, your premature infant receives much less calcium and phosphorous than if he was still in the womb. If your baby requires long-term IV nutrition, even less Ca and P will be received than from formula feedings. An added problem is that very premature babies lose much more phosphorus (P) in their urine than do term infants. If your baby is on diuretics (“water” drugs such as furosemide or “lasix”) or steroids he may also lose more calcium (Ca) in the urine than normal. Vitamin D helps with the absorption of Ca from the intestine and kidney. If babies do not receive or make enough vitamin D, they will be unable to properly absorb calcium and phosphorous. In most premature babies, too little Vitamin D is not the problem, the problem is inadequate intake or excessive loss of Ca and P. However, if your baby has a liver problem know as “cholestasis,” he may have problems with inadequate Vitamin D. Physical activity is also very important to the development of strong bones. While in the womb, fetal activity increases during the last 3 months of pregnancy and this activity is thought to be important for bone development. Most very premature infants have limited physical activity, which, along with decreased Ca and P, may contribute to weak bones.
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