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November 1989, Vol 143, No. 11 >
Article | November 1989

Serum Alkaline Phosphatase and Serum Zinc Concentrations in Preterm Infants With Rickets and Fractures FREE

Winston W. K. Koo, MBBS, FRACP; Paul Succop, PhD; K. Michael Hambidge, MBBS, FRCP, ScD
[+] Author Affiliations

Accepted for publication June 27, 1989.

Reprint requests to University of Alberta Hospitals, 3A3 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada T6G 2B7 (Dr Koo).


Am J Dis Child. 1989;143(11):1342-1345. doi:10.1001/archpedi.1989.02150230100032.
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References
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• This study aimed to determine the longitudinal changes in serum zinc concentrations and the relationship between serum alkaline phosphatase (AP) activity and serum zinc concentrations in small preterm infants. The total serum AP and serum zinc concentrations were determined serially at 3,6, 9, and 12 months in 72 infants with mean (±SEM) birth weights of 1000±29 g and gestational ages of 28.6 ± 0.3 weeks. Twenty-four of 72 infants had radiographic evidence of rickets and/or fractures (R/F). In infants with R/F, group mean (±SEM) serum AP (371 ±42 U/L) and serum zinc (12.5±1.0 μmol/L) concentrations were significantly higher at 3 months compared with infants in the non-R/F group (193±12 U/L and 9.6±0.3μmol/L, respectively). During the study, the serum AP concentrations decreased, and the serum zinc concentrations increased; both stabilized after 6 months. The serum AP concentrations were not related to the serum zinc concentrations. We speculate that in preterm infants, an increased bone turnover and a release of tissue (bone) zinc may contribute to the higher group mean serum AP and serum zinc concentrations at the time of diagnoses in infants with R/F compared with those infants without R/F.

(AJDC. 1989;143:1342-1345)

REFERENCES

1 +
Enzyme Working Group of the Subcommittee on Standards,  American Association for Clinical Chemistry, Study Group on Alkaline Phosphatase. A reference method for measurement of alkaline phosphatase activity in human serum . Clin Chem . 1983;;29:751-761.
2 +
McComb RB, Bowers GN Jr, Posen S.  Clinical utilization of alkaline phosphatase measurements . In: McComb RB, Bowers GN Jr, Posen S, eds. Alkaline Phosphatase . New York, NY: Plenum Press; 1979;:525-786.
3 +
Manolagas SC, Burton DW, Deftos LJ.  1,25-Dihydroxyvitamin D3 stimulates the alkaline phosphatase activity of osteoblast-like cells . J Biol Chem . 1981;;256:7115-7117
4 +
Sussman HH.  Structural analysis of human alkaline phosphatase . In: Stigbrand T, Fishman WH, eds. Human Alkaline Phosphatases . New York, NY: Alan R Liss Inc; 1984;:87-103.
5 +
Nanji AA.  Absence of increase of serum alkaline phosphatase activity with parenteral nutrition-associated cholestasis: possible consequences of hypozincemia and hypomagnesemia . Enzyme . 1985;;33:101-104.
6 +
Rothbaum RJ, Mauer PR, Farrell MK.  Serum alkaline phosphatase and zinc undernutrition in infants with chronic diarrhea . Am J Clin Nutr . 1982;;35:595-598.
7 +
Stammler G, Klooker P, Bommer J, et al.  Response of alkaline phosphatase to zinc repletion in hypozincemic hemodialysis patients . Blood Purif . 1985;;3:192-198.
8 +
Schiele F, Henny J, Hitz J, Pelitclerc C, Gueguen R, Siest G.  Total bone and liver alkaline phosphatase in plasma: biological variations and reference limits . Clin Chem . 1983;;29:634-641.
9 +
Crofton PM, Hume R.  Alkaline phosphatase isoenzymes in the plasma of preterm and term infants: serial measurements and clinical correlations . Clin Chem . 1987;;33:1783-1787.
10 +
Koo WWK, Antony G, Stevens LHS.  Continuous nasogastric phosphorus infusion in hypophosphatemic rickets of prematurity . AJDC. 1984;;138:172-175.
11 +
Wolf PL.  Clinical significance of an increased or decreased serum alkaline phosphatase level . Arch Pathol Lab Med . 1978;;102:497-501.
12 +
Kovar I, Mayne P, Barltrop D.  Plasma alkaline phosphatase activity: a screening test for rickets in preterm neonates . Lancet . 1982;;1:308-310.
13 +
Reddy V, Srikantia SG.  Serum alkaline phosphatase in malnourished children with rickets . J Pediatr . 1987;;71:595-597.
14 +
Bachrach S, Fisher J, Parks JS.  An outbreak of vitamin D deficiency rickets in a susceptible population . Pediatrics . 1979;;64:871-877.
15 +
Rowe JC, Wood DH, Rowe DW, Raisz LG.  Nutritional hypophosphatemic rickets in a premature infant fed breast milk . N Engl J Med . 1979;;300:293-296.
16 +
Lyon AJ, McIntosh N, Wheeler K, Williams JE.  Radiological rickets in extremely low birth weight infants . Pediatr Radiol . 1987;;17:56-58.
17 +
Koo WWK, Sherman R, Succop P, et al.  Sequential bone mineral content in very low birth weight infants with and without fractures and rickets . JBone Mineral Res . 1988;;3:193-197.
18 +
Koo WWK, Sherman R, Succop P, et al.  Fractures and rickets in very low birth weight infants: conservative management and outcome . J Pediatr Orthop . 1989;;9:326-330.
19 +
Wilkinson JH, Boutwell JH, Winsten S.  Evaluation of a new system for the kinetic measurement of serum alkaline phosphatase . Clin Chem . 1969;;15:487-495.
20 +
Meret S, Henkin RI.  Simultaneous direct estimation by atomic absorption spectrophotometry of copper and zinc in serum, urine and cerebrospinal fluid . Clin Chem . 1971;;17:369-373.
21 +
Krebs NF, Hambidge KM, Jacobs MA, Oliva-Rasbach J.  The effects of a dietary zinc supplement during lactation on longitudinal changes in maternal zinc status and milk zinc concentrations . Am J Clin Nutr . 1985;;41:560-570.
22 +
Koo WWK, Tsang RC, Steichen JJ, et al.  Vitamin D requirements in infants receiving parenteral nutrition . J Parenter Enter Nutr . 1987;; 11:172-176.
23 +
Swamy PAVB.  Efficient inference in random coefficient regression models . Econometrica . 1970;;38:311-323.
24 +
Love JT, Carter RL.  REPREG: a repeated measures regression program . Am Statist . 1983;; 37:327-328.
25 +
Glass EJ, Hume R, Hendry GMA, Strange RC, Forfar JO.  Plasma alkaline phosphatase activity in rickets of prematurity . Arch Dis Child . 1982;;57:373-376.
26 +
Shaw JCL.  Trace elements in the fetus and young infant , I: zinc. AJDC. 1979;;133:1260-1268.
27 +
Pilch SM, Senti FR.  Analysis of zinc data from the second national health and nutrition examination survey (NHANES II) . J Nutr . 1985;; 115:1393-1397.
28 +
Committee on Nutrition,  American Academy of Pediatrics. Nutritional needs of low birth weight infants . Pediatrics . 1985;;75:976-986.
29 +
Koo WWK, Tsang RC.  Bone mineralization in infants . Prog Food Nutr Sci . 1984;;8:229-302.
30 +
Koo W, Sherman R, Succop P, Ho M, Buckely D, Tsang RC.  Sequential serum vitamin D metabolites in very low birth weight infants with and without rickets/fractures . J Pediatr . 1989;;114: 1017-1022.
31 +
Koo WWK, Tsang RC, Poser JW, et al.  Elevated serum calcium and osteocalcin levels from calcitriol in preterm infants: a prospective randomized study . AJDC . 1986;;140:1152-1158.
32 +
Walravens PA, Hambidge KM.  Growth of infants fed a zinc-supplemented formula . Am J Clin Nutr . 1976;;29:1114-1121.
33 +
Hambidge KM, Walravens PA, Casey CE, Brown RM, Bender C.  Plasma zinc concentrations of breast-fed infants . J Pediatr . 1979;;94:607-608.

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References

1 +
Enzyme Working Group of the Subcommittee on Standards,  American Association for Clinical Chemistry, Study Group on Alkaline Phosphatase. A reference method for measurement of alkaline phosphatase activity in human serum . Clin Chem . 1983;;29:751-761.
2 +
McComb RB, Bowers GN Jr, Posen S.  Clinical utilization of alkaline phosphatase measurements . In: McComb RB, Bowers GN Jr, Posen S, eds. Alkaline Phosphatase . New York, NY: Plenum Press; 1979;:525-786.
3 +
Manolagas SC, Burton DW, Deftos LJ.  1,25-Dihydroxyvitamin D3 stimulates the alkaline phosphatase activity of osteoblast-like cells . J Biol Chem . 1981;;256:7115-7117
4 +
Sussman HH.  Structural analysis of human alkaline phosphatase . In: Stigbrand T, Fishman WH, eds. Human Alkaline Phosphatases . New York, NY: Alan R Liss Inc; 1984;:87-103.
5 +
Nanji AA.  Absence of increase of serum alkaline phosphatase activity with parenteral nutrition-associated cholestasis: possible consequences of hypozincemia and hypomagnesemia . Enzyme . 1985;;33:101-104.
6 +
Rothbaum RJ, Mauer PR, Farrell MK.  Serum alkaline phosphatase and zinc undernutrition in infants with chronic diarrhea . Am J Clin Nutr . 1982;;35:595-598.
7 +
Stammler G, Klooker P, Bommer J, et al.  Response of alkaline phosphatase to zinc repletion in hypozincemic hemodialysis patients . Blood Purif . 1985;;3:192-198.
8 +
Schiele F, Henny J, Hitz J, Pelitclerc C, Gueguen R, Siest G.  Total bone and liver alkaline phosphatase in plasma: biological variations and reference limits . Clin Chem . 1983;;29:634-641.
9 +
Crofton PM, Hume R.  Alkaline phosphatase isoenzymes in the plasma of preterm and term infants: serial measurements and clinical correlations . Clin Chem . 1987;;33:1783-1787.
10 +
Koo WWK, Antony G, Stevens LHS.  Continuous nasogastric phosphorus infusion in hypophosphatemic rickets of prematurity . AJDC. 1984;;138:172-175.
11 +
Wolf PL.  Clinical significance of an increased or decreased serum alkaline phosphatase level . Arch Pathol Lab Med . 1978;;102:497-501.
12 +
Kovar I, Mayne P, Barltrop D.  Plasma alkaline phosphatase activity: a screening test for rickets in preterm neonates . Lancet . 1982;;1:308-310.
13 +
Reddy V, Srikantia SG.  Serum alkaline phosphatase in malnourished children with rickets . J Pediatr . 1987;;71:595-597.
14 +
Bachrach S, Fisher J, Parks JS.  An outbreak of vitamin D deficiency rickets in a susceptible population . Pediatrics . 1979;;64:871-877.
15 +
Rowe JC, Wood DH, Rowe DW, Raisz LG.  Nutritional hypophosphatemic rickets in a premature infant fed breast milk . N Engl J Med . 1979;;300:293-296.
16 +
Lyon AJ, McIntosh N, Wheeler K, Williams JE.  Radiological rickets in extremely low birth weight infants . Pediatr Radiol . 1987;;17:56-58.
17 +
Koo WWK, Sherman R, Succop P, et al.  Sequential bone mineral content in very low birth weight infants with and without fractures and rickets . JBone Mineral Res . 1988;;3:193-197.
18 +
Koo WWK, Sherman R, Succop P, et al.  Fractures and rickets in very low birth weight infants: conservative management and outcome . J Pediatr Orthop . 1989;;9:326-330.
19 +
Wilkinson JH, Boutwell JH, Winsten S.  Evaluation of a new system for the kinetic measurement of serum alkaline phosphatase . Clin Chem . 1969;;15:487-495.
20 +
Meret S, Henkin RI.  Simultaneous direct estimation by atomic absorption spectrophotometry of copper and zinc in serum, urine and cerebrospinal fluid . Clin Chem . 1971;;17:369-373.
21 +
Krebs NF, Hambidge KM, Jacobs MA, Oliva-Rasbach J.  The effects of a dietary zinc supplement during lactation on longitudinal changes in maternal zinc status and milk zinc concentrations . Am J Clin Nutr . 1985;;41:560-570.
22 +
Koo WWK, Tsang RC, Steichen JJ, et al.  Vitamin D requirements in infants receiving parenteral nutrition . J Parenter Enter Nutr . 1987;; 11:172-176.
23 +
Swamy PAVB.  Efficient inference in random coefficient regression models . Econometrica . 1970;;38:311-323.
24 +
Love JT, Carter RL.  REPREG: a repeated measures regression program . Am Statist . 1983;; 37:327-328.
25 +
Glass EJ, Hume R, Hendry GMA, Strange RC, Forfar JO.  Plasma alkaline phosphatase activity in rickets of prematurity . Arch Dis Child . 1982;;57:373-376.
26 +
Shaw JCL.  Trace elements in the fetus and young infant , I: zinc. AJDC. 1979;;133:1260-1268.
27 +
Pilch SM, Senti FR.  Analysis of zinc data from the second national health and nutrition examination survey (NHANES II) . J Nutr . 1985;; 115:1393-1397.
28 +
Committee on Nutrition,  American Academy of Pediatrics. Nutritional needs of low birth weight infants . Pediatrics . 1985;;75:976-986.
29 +
Koo WWK, Tsang RC.  Bone mineralization in infants . Prog Food Nutr Sci . 1984;;8:229-302.
30 +
Koo W, Sherman R, Succop P, Ho M, Buckely D, Tsang RC.  Sequential serum vitamin D metabolites in very low birth weight infants with and without rickets/fractures . J Pediatr . 1989;;114: 1017-1022.
31 +
Koo WWK, Tsang RC, Poser JW, et al.  Elevated serum calcium and osteocalcin levels from calcitriol in preterm infants: a prospective randomized study . AJDC . 1986;;140:1152-1158.
32 +
Walravens PA, Hambidge KM.  Growth of infants fed a zinc-supplemented formula . Am J Clin Nutr . 1976;;29:1114-1121.
33 +
Hambidge KM, Walravens PA, Casey CE, Brown RM, Bender C.  Plasma zinc concentrations of breast-fed infants . J Pediatr . 1979;;94:607-608.

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