BONE MINERAL CONTENT (BMC) IN CYSTIC FIBROTIC hYDROGIIN ION [HI+ LOAD AND CALCIUM-P309PFATE SXE12TTL PATIENTS WITH NORMAL VITAMIN 0 STATUS. IN IV IIUTRITION AND THE FRETERK INFANT (PTI) M.Moya, M.Juste, 1.Ballester and M.J.Can~pello. P KecMahon. P Majine, M Elair, C Pope, I Kovar. Depts 17 Ped.Dep.Hosp.Provincia1. University of Alli- 20 of Chld Hlth & Chem Path, Charing Cr11s.s & Westminster cante. Spain. Medical School. London, UK. Poor n~ineralizationin CF patients has been reported in vivo since last decade. A group of 7 well controlled CF patients Significant ssteopenie occurs in circa 30% of PTI. Inadequete (aged 8.19.5 y) with normal faeces was studied. They received Creon mineral substrate intake to match intrauterine accretion rates (5-11 capsules/day) and vitamin D (400-2400 IU/day). The Schwachman is thought to be a major cause. Calcium (Ca) and Phosphate (iP) test ranged 55-90. An age matched control group of 7 healthy chil- intake in IV feeding is restricted by solution solubility to less dren was also studied. BMC, by dual-photon absorptiometry (153 Gd) than half the desired intake. 17 IT1 (median wt l.ZOkg, gest of trabecular bone in lumbar vertebrae was used. Standard deviation 28w) were entered into a cross-over study comparing Addiphos score for height were less than 1 SO in both groups. (Kabi?litrum) and K;! HPO4 as the iP source, while keeping axino Ca Alk-P 250 24,250 1,25 BMC/YW acid intake standard. Results: (i) An increase in Ca - iP mo/dL-. u/L no/mL no/mL ~o/mL a/cm solubility and increased Ca and iP intake (P<0.001) can be achia~ed CF 9.6z.5 168i48 15:3c4.4 1Y9c.8 2bZ4l .55c.04 by lowering soluticn pH using Addighos instead of K2HP0 4. (ii) Control 9.52.4 2202117 18.823.2 1.82.4 74245 .71+.1 Plasma Ca and iP is significantly increased with Addiphos (P<0.01). * *. t (iii) To match intrauterine Ca and iP accretion there'was ;I 2x **: p(0.001; +: p(0.025; msD increase in [HI- load. (iv) With (iii)there was no signifi-ant Vit 0 nutritional status is in the low normal range and reasonable change in blood acid-base parameters., but there was an incrsase for winter. Using bone width (BW) concept, bone mineral content shows in urine titratable acidity excretion. Conclusion: Intravenous a significant reiuction in CF group, similar to osteoporotic adults. Ca and iP concentraticn of infusion can be increased by lowering This can be due to calcium ntalabsorption. The significant rise in pH of parenteral solution using Addiphos. This increased [HIe 1,25 0 reflects the body's calcium needs. Extra calciun~and/or vit D load is well tolerated by PTI. supplements are probably required for those patients.

MINERAL CONTENT OF THE HUMAN SKULL DURING DEVELOPMENT. MAGNESIUM METABOLISM IN PRETEHM INFANTS: THE EFFECT Neville R. Belton and Ian I. Smith, Department of OF CALCIUM AND PHOSPHORUS. Ian A. Laing, Merete M. Child Life and Health, University of Edinburgh, and Giles, Robert A. Elton, James El. Robins, Margaret B. 18 Pathology Department, Royal Hospital for Sick Children, 21 Sanderson and Robert Hume. From the Department of Edinburgh, Scotland, U.K. Child Life and Health, and the Medical Computing and Statistics Unit, University of Edinburgh, Scotland. Measurements of mineral accumulation in infancy are usually referable to cartilaginous bones and yet the membranous Studies on rlcXets of prematurity have focussed on the calcium, skullbones of preterm infants are palpably soft and craniotabes is phosphorus and vitamin D requirements of infants, but skeletal well recognised in preterm and fullterm infants. Hardening of the development may be stressed if masnesium is deficient. The vault and increasing radiological density occur with growth and present study examines the effects of increasing calcium and maturation. Calcium and magnesium contents were measured in post- phosphorus on magnesium retention. Five groups of very low mortem samples of frontal bone from 108 children aged from 20 weeks birthweight infants were fed milk with magnesium content gestation to 10 months of life. Samples of bone were dried, ashed 5 mgI100 ml. Calcium and phosphorus were supplemented to the and the mineral content determined by atomic absorption spectro- followin3 concentrations (Ca:P mgllOO ml); Croup A 44:33, photometry. A small progressive increase in calcium/100 g tissue Group B 84:33, Group C 125:33, Group D 125:50 and Group E 125:64. was seen in stillbirths and early neonatal deaths in the second Three-day balance studies were performed starting at 10, 20, 30 half of gestation, 21.7g/100 g at 28 weeks to 22.6 g/100 g bone at and 40 days. Increasins both calcium and phosphorus contents 40 weeks (r = 0.23, p <0.02), but there was little subsequent decreased macnesium retention to lower than in utero accretion change over the first year of life. The calcium content of many rates. Doublin~magnesium content of milk to 10 mgI100 rnl did infants dying more than 7 days after birth was reduced. Calcium not prevent negative magesium balance in very preterm infants and magnesium contents were strongly correlated (r = 0.34, at 10 days, althouzh magnesium retention doubled in older p <0.001) over the whole range of gestqtions studied. (Magnesium (20 days) or more mature (32-34 weeks gestation) infants. content at 40 weeks gestation = 0.307 - 0.030 (SO), n.19). Our We conclude that increasing calcium and phosphorus content of results are similar to previous data reported on cartilaginous long milks to prevent rickets of prematurity could produce a bones (femur and humerus) and suggest that mineral accretion in magnesium deficiency in very low birthweight infants, with cartilaginous and membranous bones is similar in early development. possible compromise of bone formation.

D+L emqy dasitaretcy (IIXD) of bcne LFECT OF SUPPLE1IENTAL PHOSPHORUS ON RED CELL PHOSPHATE IN PRETERn AM) FULL TERn NEHBORNS (Preliminary report). rmwal mrtart (EH.2) in pretem babies V. Cholevae. S. A.Challa P.D. . .. -.~-., - Andronikou.- - - , ~ and Laoatsanis: S.Aylett, M.Dom, F.Chan, A.Lyon, P.Hanilton n Child Health Deot., Universitv of Ioannina, Ioannina-Greece. 19 George's LL Phosphate changes in plasma and erythrbcytes were studied in E~~AJ~ZWZI~of child Wth, St Baspit', pretern and fullterm infants during the first two weeks of life. -, UK G:wp I : three preterm infants with no problems, mean gestational age (GA) 33.St1.51tSD) weeks and nean birth weight (B.W) 2010t250gm DXD was used to xeasue BMC in preterm infants ,< 30 (tSD), group I1 : nix preterm infants vith problems (3 respiratory distress smdrom, 2 septicaemia, i necratizing enterocolitis) mean GA 3421.7 weeks, weeks gestational age (GA) fed foda milk mrrplying with mean B.W 2260t490 gm; group I11 : four full tern infants with problems (2 with birth reammexled guidelines for calcium (Ca) and phosphorus (P) content asphyxia and 2 with meconium aspiration) with mean BW 35502490gm. Blood samples were dram on 1st. 4th, 7th 10th and 14th day of life. All babies vith problems received and ratio. DXD images were obtained at 48 hours of age and at glucose 10%and calcium glucanate 10% (40mg/Kg/day) for the first 48 hours of life weekly or 2 weekly intervals until term. Xesults from 9 infants and TPN or infant Formula thereafter. The mean phosphate intake in mg/Kg/day from day are available. Mean (2 SD) FMC at birth was 2.7 (_+1.5) q/m and 4 to day 14 ranged in group I from 49r9 to hot17 (meantSD) in group I1 from 44220 at 6 weeks postnatal age (PNA) was 2.0 (_+ 0.5) ~rg/m. 5 babies to 6324.1 and in group 111 from 24214 to 4125. Plasma and red cell (RBC) Pi in bath groups of pretenw showed a steady increase during the study. There was no difference studied at term had a mean (2 SD) BMC of 3.7 (2 1.1) nq/m. between normal and problematic preterm infants. In the full term newbarns with The expzkd FMC of n-m infants of this GA Lawe is 3.2 (2 0.6) problem Pi remained unchanged extra and intracellularly. ny/m an3 of newborn infants at term is 9.2 (2 1.8) ny/ml. Days 1st 4th 14th One infant developed a fracture of the f-. His PMC fell from 2.3 RBC Pi Plasma Pi RBC Pi Plasma Pi RBC Pi Plasma Pi Group I 1.5t0.6 5.0t0.4 1.8t0.7 6.lt1.3 3.021.0 7.6t0.6 q/m to 0.8 q/m in the first week of life an3 was 0.2 q/m at 8 Crou~I1 1.8t0.8 5.0t0.7 2.3-0.6 6.021.3 2.9'0.9 7.620.6 wee.. PNA. The fracture was deteded at 14 weeks FNA at bhich ti= Cmnn TTT 1.4-0.3 S.0i0.3 2.010.7 6.2fO.7 2.020.2 6.010.7 the FMC was 3.3 q/m. tii;;s-&e exp;&Z-as L&~~sDin-mgjdf. FMC increase in The red cell oranic phosphate cancentrat~onsof ATP and 2.3DFG seem to follow We conclude that did not in these babies as it Zces inorganic phosphate changes. The renal phosphate reabsorption index IhP/GFR increased utero and at term was well below the expdd value. Risk of progressively in all three groups of babies over the first 2 weeks of life. Sick fracture my he predictd fmm very low BMC. Supplanentation of preterm and fullterm neonates increased their ability to retain Pi during this study Ca period. The lower Pi values in problematic fullterm infants were probably due ta the foda milk with and P may not he sufficient to @me lower Pi intake. This study indicates that by altering supplementation of phosphate mineralisation and other factors mt be investigated. we can alter VhosDhate retention in neonates.