ArticleBMC pediatrics2026
Biomarkers of phosphate homeostasis and metabolic bone disease of prematurity: impact of early nutrition and regulation by vitamin D, iPTH, PTHrP, and FGF23.
Article in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGlobal practices for supplementing calcium, phosphate, and vitamin D in early life, as well as for screening for metabolic bone disease of prematurity (MBDP), remain inconsistent. Furthermore, researchers have not yet established gestational age (GA)-specific reference intervals for phosphate homeostasis biomarkers. This study aimed to assess phosphate homeostasis parameters and MBDP risk factors under local neonatal nutritional practices and to characterize the serial levels of key hormones involved in phosphate metabolism, including 1,25-dihydroxyvitamin D (1,25(OH)2D), intact parathyroid hormone (iPTH), parathyroid hormone-related protein (PTHrP), and fibroblast growth factor-23 (FGF23).
methodsWe conducted a prospective cohort study in 657 preterm infants with GAs of 26–36+ 6 weeks. We analysed serum phosphate (sP), calcium (sCa), and alkaline phosphatase (ALP) levels across different GAs and postnatal ages, and we identified risk factors for MBDP using univariate and multivariate logistic regression analyses. In a separate, in-depth cohort of 63 preterm infants, we measured and analysed urinary phosphate (uP), calcium (uCa), tubular reabsorption of phosphate (TRP), renal phosphate threshold concentration (Tp/GFR), and these hormones, and we assessed correlations using Pearson’s test.
resultsExtremely preterm infants (EPIs) and very preterm infants (VPIs) developed low sP (median nadir: 1.54 mmol/L; interquartile range, IQR: 1.21–2.03), low sCa (nadir: 2.15 mmol/L; IQR: 2.07–2.22), and hypophosphaturia (uP nadir: 0.71 mmol/L; IQR: 0.31–1.66), along with elevated uCa (peak: 1.46 mmol/L; IQR: 1.18–1.70) and secondary hyperparathyroidism (peak iPTH: 29.2 pmol/L), which reflects insufficient early-life calcium-phosphate (Ca-P) intake. We observed lower sP levels (1.27 ± 0.20 mmol/L) in infants who started extra vitamin D supplementation after 14 postnatal days and in those with prolonged parenteral nutrition (PN) exposure. Our analysis showed a positive correlation between Tp/GFR and GA. We found no GA-based differences in the measured hormone levels. PTHrP levels progressively declined from umbilical cord blood (10.9 ± 2.4 pmol/L) to postnatal day 14 (9.1 ± 2.0 pmol/L). In contrast, initially very low iPTH levels (median 1.9 pmol/L) increased sharply after birth (median 28.3 pmol/L). FGF23 levels remained elevated throughout the study period.
conclusionsOur study reveals suboptimal Ca intake from PN, insufficient Ca-P supply via enteral nutrition (EN), and delayed vitamin D supplementation in the current local early-life nutrition protocol. The high prevalence of maternal vitamin D deficiency likely contributed to the vitamin D insufficiency that we observed in most preterm infants. Clinicians should utilize biomarkers including sP, sCa, uP, uCa, and iPTH to assess phosphate homeostasis and guide mineral supplementation in early life to reduce the incidence of MBDP.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.