Four preterm infants of very low birthweight (less than 1500 g) developed signs of copper deficiency between age 8 and 10 weeks. All had required prolonged ventilatory support, parenteral nutrition, and nasojejunal feeding. The clinical features, which included osteoporosis, oedema, anaemia, neutropenia, and late apnoea improved when the oral copper intake was increased. Diagnosis was made more difficult because a suitable reference range for plasma copper was not available. Serial measurements of plasma copper in 39 preterm infants who had no important medical problems were used to produce a reference range for plasma copper from 30 weeks' gestation to term plus seven weeks. This information will aid recognition of hypocupraemia in the very low birthweight infant who is particularly at risk of copper deficiency.
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