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High frequencies of elevated alkaline phosphatase activity and rickets exist in extremely low birth weight infants despite current nutritional support
BMC Pediatrics, 07/30/09

Mitchell SM et al. – Elevation of P–APA >600 IU/L was very common in ELBW infants. BW was significantly inversely related to both P–APA and rickets. No single value of P–APA was related to radiological findings of rickets. Given the very high risk of osteopenia and rickets among ELBW infants, authors recommend consideration of early screening and more aggressive mineral supplementation, especially among infants <600g BW.

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