Rickets of premature infants induced by calcium deficiency. A case report.

Rickets of prematurity is not uncommon in neonatal intensive care units. Nutritional rickets in childhood is usually caused by vitamin D deficiency, but the rickets of prematurity is mainly attributable to calcium and phosphorus deficiencies. We present a premature infant with sequelae of necrotizing enterocolitis who needed prolonged administration of total parenteral nutrition (TPN), and who sustained ricketic fracture. After high calcium-fortified TPN supplementation the fracture healed well, and serum alkaline phosphatase dropped. This finding shows (1) serum calcium and phosphorus levels are of predictive value regarding rickets, (2) regular follow-ups of alkaline phosphatase levels combined with radiography in high-risk groups of premature infants are good tools for monitoring rickets, and (3) prolonged TPN administration needs to contain higher calcium and phosphorus concentrations in prematurity than in childhood.