Failure of High Calcium and Phosphorus Supplementation in the Prevention of Rickets of Prematurity

Sir.—Several investigators have recently reported the preliminary results of the use of calcium (Ca) and phosphorus (P) supplements to prevent Ca and P deficiency and to improve bone mineralization for small preterm infants fed their own mothers' milk (OMM).^1,2 We report the failure of prevention of rickets and severe bone demineralization in an extremely low-birth-weight infant despite the use of high Ca and P formula added to OMM.

Patient Report.—A 660-g female neonate was delivered at 30 weeks' gestation for severe maternal preeclampsia. Her Apgar scores were 2 and 4 at one and five minutes, respectively. She required ventilator support for 50 days and a further 45 days of oxygen therapy. Nutritional support included total and supplementary parenteral nutrition for ten days. Feeding by the "bolus" gavage technique with OMM was commenced at age 9 days and reached 150 mL/kg/d or greater from 17 days. She regained