Surreal illustration of an infant cradled in a hand, symbolizing bone health.

Rickets in Newborns: What Parents Need to Know About Prevention and Treatment

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"A comprehensive guide to understanding rickets in extremely low birth weight infants, including risk factors, prevention strategies, and treatment options."

Rickets, a condition characterized by the softening and weakening of bones, is a significant concern for extremely low birth weight (ELBW) infants. While advancements in neonatal care and nutrition have been made, the incidence of rickets remains surprisingly high in this vulnerable population. Understanding the risk factors and implementing preventive strategies are crucial for ensuring optimal bone health in these newborns.

Historically, rickets was prevalent among ELBW infants due to inadequate mineral intake. The introduction of mineral-enriched formulas in the late 1980s aimed to address this deficiency, leading to a decrease in rickets cases. However, recent studies indicate that the incidence of rickets in ELBW infants is still a concern, highlighting the need for a renewed focus on this issue.

This article delves into the complexities of rickets in ELBW infants, exploring the factors that contribute to its development, effective prevention methods, and available treatment options. By providing comprehensive information and practical advice, we aim to empower parents and caregivers to protect the bone health of their newborns.

Why Are ELBW Infants at Higher Risk for Rickets?

Surreal illustration of an infant cradled in a hand, symbolizing bone health.

ELBW infants face numerous challenges that increase their susceptibility to rickets. These challenges include:

Inadequate Mineral Intake: Despite advancements in nutritional formulas, achieving optimal mineral intake remains difficult. ELBW infants often have difficulty tolerating full enteral feeds, leading to reliance on parenteral nutrition, which may not provide sufficient minerals.

Premature Gut Development: The immature digestive systems of ELBW infants may not efficiently absorb essential minerals like calcium and phosphorus.
Chronic Co-morbidities: Conditions like bronchopulmonary dysplasia (BPD) and parenteral nutrition-associated cholestasis (PNAC) further impair mineral absorption and bone mineralization.
Medications: Certain medications commonly used in neonatal intensive care units (NICUs), such as diuretics and steroids, can interfere with bone metabolism.

A recent study published in the Journal of Korean Medical Science revealed a high incidence of rickets (44%) among ELBW infants. The study also identified severe PNAC and moderate/severe BPD as significant risk factors for rickets in this population. These findings underscore the importance of addressing these co-morbidities to prevent rickets.

Protecting Your ELBW Infant from Rickets: A Call to Action

Rickets remains a significant threat to the bone health of ELBW infants, but early intervention and proactive management can make a difference. By understanding the risk factors, optimizing nutrition, and addressing co-morbidities, parents and healthcare providers can work together to protect these vulnerable newborns from the debilitating effects of rickets. Stay informed, advocate for your child's needs, and prioritize their bone health for a brighter, healthier future.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3346/jkms.2012.27.12.1552, Alternate LINK

Title: High Incidence Of Rickets In Extremely Low Birth Weight Infants With Severe Parenteral Nutrition-Associated Cholestasis And Bronchopulmonary Dysplasia

Subject: General Medicine

Journal: Journal of Korean Medical Science

Publisher: Korean Academy of Medical Sciences

Authors: Soon Min Lee, Ran Namgung, Min Soo Park, Ho Sun Eun, Kook In Park, Chul Lee

Published: 2012-01-01

Everything You Need To Know

What is rickets, and why is it a concern for extremely low birth weight (ELBW) infants?

Rickets is a condition that causes the softening and weakening of bones. It is a significant concern for extremely low birth weight (ELBW) infants because they are particularly vulnerable. Their bones may not develop properly due to various factors, leading to potential health complications. This can impact their overall growth and development, making early diagnosis and intervention essential.

What are the primary risk factors that make ELBW infants susceptible to developing rickets?

Several factors contribute to the higher risk of rickets in ELBW infants. These include inadequate mineral intake, often due to difficulties in tolerating full enteral feeds and reliance on parenteral nutrition which may not provide sufficient minerals. The immature digestive systems of these infants may not efficiently absorb essential minerals like calcium and phosphorus. Chronic co-morbidities, such as bronchopulmonary dysplasia (BPD) and parenteral nutrition-associated cholestasis (PNAC), also impair mineral absorption and bone mineralization. Furthermore, certain medications commonly used in NICUs can interfere with bone metabolism.

How does inadequate mineral intake contribute to the development of rickets in ELBW infants, and what are the solutions?

Inadequate mineral intake is a crucial factor. Even with mineral-enriched formulas, achieving optimal levels can be difficult. ELBW infants often struggle with full enteral feeds, leading to reliance on parenteral nutrition. The parenteral nutrition may not always provide the necessary minerals in sufficient quantities or in bioavailable forms. To address this, healthcare providers focus on optimizing nutritional strategies, carefully monitoring mineral levels, and potentially supplementing with calcium, phosphorus, and vitamin D, guided by regular blood tests.

What is the role of co-morbidities like bronchopulmonary dysplasia (BPD) and parenteral nutrition-associated cholestasis (PNAC) in rickets, and how are these managed?

Conditions like bronchopulmonary dysplasia (BPD) and parenteral nutrition-associated cholestasis (PNAC) exacerbate the risk of rickets. BPD can affect lung function and overall health, indirectly influencing bone health. PNAC impairs the liver's ability to process nutrients, including those vital for bone development. Managing these co-morbidities is essential. This includes supporting respiratory function in BPD cases and optimizing liver health through dietary adjustments and medications in PNAC cases. Addressing these conditions helps improve mineral absorption and bone mineralization, reducing the risk of rickets.

What preventive measures and treatments are available to protect ELBW infants from rickets?

Preventive measures focus on optimizing nutrition and addressing co-morbidities. This involves ensuring adequate mineral intake through appropriate formula selection, potentially supplementing with calcium, phosphorus, and vitamin D, and carefully monitoring mineral levels. For infants experiencing challenges with enteral feeds, the parenteral nutrition composition should be optimized to include essential minerals. Addressing co-morbidities such as BPD and PNAC is also crucial, as their management indirectly supports bone health. Regular monitoring and early intervention are key to a brighter, healthier future for these vulnerable newborns.