Metabolic Bone Disease of Prematurity: Report of Four Cases (original) (raw)
Approach to Metabolic Bone Disease of Prematurity
VIMS Health Science Journal
Neonatal metabolic bone disease (MBD), osteopenia of prematurity (OOP), neonatal rickets or rickets of prematurity, are terms used to describe a reduction in bone mineral content (BMC) of the preterm infant. Although its exact prevalence is difficult to quantify because of the various methods used for screening of infants who are at risk and also because of the difficulty in the interpretation of these results, it has been steadily increasing with the survival of more immature neonates as a result of advances in neonatal care. Pathological conditions which impair placental macro and micronutrients transfer, such as preeclampsia, intrauterine growth restriction, and chorioamnionitis are associated with an increased risk of MBD in preterm infants. There are no specific diagnostic methods for MBD of prematurity. The clinical findings appear late and sometimes the diagnosis is not carried out. Indeed, it is necessary to screen the subjects who are at risk to develop MBD. The prevalence ...
2017
Metabolic bone disease (MBD) of prematurity is mainly caused by inadequate amount of calcium and phosphate in parenteral nutrition admixtures given to premature infants in early days of life before full enteral feeding is established. According to published guidelines/ survey of parenteral nutrition for premature infants in Australia, USA and Europe, it is still a common practice to prepare parenteral nutrition admixtures with calcium and phosphate concentration not high enough to achieve the fetal accretion rate. Therefore, as these bones of premature infants grow without adequate supply of calcium and phosphorus, they are under-mineralized. MBD of prematurity is still prevalent worldwide. Solubility of calcium and phosphate has been a limiting factor for provision of adequate amounts of calcium and phosphate in parenteral nutrition. However, this is no longer true because for more than a decade there have already been studies on the use of organic phosphate and organic calcium in ...
Metabolic Bone Disease of Prematurity: A Review of Minerals Supplementation and Disease Monitoring
Journal of Neonatal Biology, 2015
Metabolic bone disease is a frequent condition in very low birth weight (VLBW) infants. In order to prevent the disease, the provision of high amount of calcium and phosphate in parenteral nutrition solutions and during transition to the full enteral feedings is crucial. Current practice supports early aggressive mineral supplementation. In this review, we will discuss data from the recent literature regarding the recommendation for supplementation of calcium, phosphate and vitamin D in VLBW infants and the interpretation of indirect markers of bone metabolism for screening, diagnosis and monitoring high risk infants, as well as to guide treatment.
Osteopenia in Premature Infants and Effect of Supplementation
Bangladesh Journal of Child Health, 2017
Background: Despite advances in antenatal and prenatal care, incidence of preterm labor is still high. Osteopenia of prematurity is one of the common accompaniments or complications of surviving preterm babies. Most of the time this problem remains hidden, so is untreated by most of the physicians which leads to growth retardation, delayed bone maturation, fractures with minimal trauma and other complications in infancy. Objective: This study was an attempt to see osteopenia in preterm babies admitted in hospital and to see the effect of supplementation with calcium and phosphorus on those babies and to corelate serum calcium and phosphorus level with gestational age and bone density. Methods: A total 96 of preterm babies admitted in Dhaka Shishu (Children) Hospital (DSH) and Maternal & Child health Training Institute (MCHTI) of either sex were selected randomly during the period of January 2005 to June 2006. Venous blood was tested for serum calcium and phosphorus level and X-ray of lower limb to see bone density. All cases were given calcium 200 mg/kg/day and phosphorus 90 mg/kg/day with multivitamin drop of 6 drops/day up to 3 months of age. Result: Out of 96 preterm babies 27 had osteopenia with male preponderance [67%]. Gestational ages were between 28-32 weeks and in 78% cases weight were with 1000-1500 gm. Most of the mothers were 18-25 years and housewives. Initial mean serum calcium level was 1.66 mmol/l and phosphorus level was 1.58 mmol/l. After 3 months of supplementation, it was 2 mmol/l and 2.08 mmol/l respectively. Serum alkaline phosphatase was initially 736.6 and follow up level after 3 months was 353.14. Weight also increased, it was[mean] 3448 g whereas initial weight was 1277 gm.There was significant reduction of alkaline phosphatase during the 3 months [P < 0.05]. Conclusion: Prevalence of osteopenia is high (28%) in premature infants. Less the gestational age more the chance of osteopenia. Calcium and Phosphorous supplementation has showed very good effect to achieve normal growth pattern.
Annals of Medicine & Surgery, 2021
Determining neonatal and maternal factors that are associated with the incidence of OFP. Methods: This study employed a cross-sectional design, in which the participants were identified for clinical variables (sex, gestational age, birth weight, etc.), neonatal morbidity (sepsis, necrotizing enterocolitis (NEC), etc.), and maternal risk factors (premature rupture of membranes, preeclampsia, etc.). The data were analyzed using Chi-square test, independent t-test, and logistic regression test with p < 0.05. Results: The birth weight ranged from 800 to 1495 g (1219 ± 225 g), of which 5 newborns (17%) were <1000 g. The gestational age ranged from 27 to 32 weeks, with a mean of 29 ± 1.5 weeks. The signs of OFP were observed in 13 (43%) infants, of which 2 (15%) OFP infants had a birth weight <1000 g. There was significant difference in parenteral nutrition duration (p = 0.018), onset of vitamin D supplementation (p = 0.019), and ALP level (p = 0.012) of infants between the OFP group and the non-OFP group. The variables associated with the incidence of OFP were parenteral nutrition duration >15 days (OR = 5.4; 95% CI 1.120-26.044; p = 0.036), ALP level >500 U/L (OR = 2.889; 95% CI 1.703-4.900; p = 0.014), and PROM (OR = 5.4; 95% CI 1.039-28.533; p = 0.045). Conclusion: The lack of phosphate intake, prolonged parenteral nutrition, ALP level >500 U/L, onset of vitamin D supplementation, and premature rupture of membranes are associated with the incidence of OFP.
Role of Biochemical Parameters for The Detection of Osteopenia of Prematurity
Northern International Medical College Journal, 2024
Background: Complications from preterm birth are the leading causes of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015. Three-quarters of these deaths could be prevented with current, cost-effective interventions. Premature infants, particularly those born at <28 weeks of gestation, are at significant risk for reduced bone mineral content (BMC) and subsequent bone disease, variably termed metabolic bone disease (MBD), osteomalacia, osteopenia, or neonatal rickets. Risk of fracture and growth failure increase in the presence of osteopenia in these infants. Early detection of Osteopenia of Prematurity (OOP) may prevent unwanted deaths. Objectives: To identify biochemical markers of osteopenia in the neonatal period for early detection before the appearance of radiological evidence of osteopenia. Methods: This prospective observational study was carried out at Dhaka Shishu Hospital (DSH) from July, 2016 to June, 2018. Babies admitted in the Neonatal Intensive Care and Special Care Baby Unit with gestational age <34 weeks and birth weight <2200 gm were included in the study. Purposive sampling technique was used to collect the study data. Blood sample for baseline biochemical markers were collected in 1st week of life, then subsequently at 2 weeks interval up to corrected term age. Wrist radiography was done for to detect radiological osteopenia at 6th week post-natal age and at corrected term age. Then the biochemical parameters are compared with radiological osteopenia. Result: This study included 84 preterm new born below 34 weeks of gestation and a birth weight below 2200 grams. Radiological evidence of osteopenia of prematurity was found in 34 (40.5%) babies of which 29 (85.3%) were below 32 week and 5 (14.7%) were at or above 32 weeks. Osteopenic infants had significantly (p<0.001) lower birth weight (1318.82 ± 264.23 gm) compared to non-osteopenic infants (1701.40 ± 431.11 gm). Our study showed that the optimal cutoff point for Alkaline phosphatase (ALP) was 352.50 U/L at 3rd week of life, at which sensitivity and specificity were found 82.4% and 80.0% respectively. Serum inorganic phosphate values for the diagnosis of osteopenia was 4.67 mg/dl at 5th week of age. At this level, sensitivity was found to be 68.0%, whereas specificity was 60.0%. Serum calcium of the infants did not show any significant difference when they were enrolled in the study and in the first follow up. But serum calcium level was significantly lower in osteopenic infants compared to nonosteopenic infants in 2nd and 3rd follow up (p<0.05). Conclusion: High alkaline phosphatase level at 3rd week of life and low serum inorganic phosphate at 5th week of life can be used as a predictor of osteopenia of prematurity.
Metabolic bone disease of prematurity and secondary hyperparathyroidism
Journal of Paediatrics and Child Health, 2011
To illustrate, via case histories, the importance of laboratory investigations for the early diagnosis and management of metabolic bone disease (MBD). Methods: We report three cases of extreme premature infants with MBD. Results: These three infants had several risk factors for MBD of prematurity: very low birthweight, delayed enteral feeds, cholestatic liver disease, intolerance of fortification, the use of glucocorticoids and diuretics. Serum alkaline phosphatase and parathyroid hormone (PTH) were elevated despite relatively normal calcium and phosphate levels. These parameters were corrected with additional supplementation of calcium, phosphate and vitamin D. Conclusions: Infants born extremely prematurely have significant calcium and phosphate depletion by the time they reach full term compared with the normal fetal accretion rate. This is exacerbated if there is poor tolerability to feeds where extra calcium and phosphate could not be added either by additives or via human milk fortifier. Serum calcium and phosphate levels may be normal despite inadequate intake or stores due to the counter-regulatory effect of PTH. In infants at risk of MBD, testing serum alkaline phosphatase, vitamin D and PTH with calcium and phosphate may assist in the monitoring and management of MBD.
Serial serum alkaline phosphatase as an early biomarker for osteopenia of prematurity
Medicine, 2016
Metabolic bone disease of prematurity is a condition characterized by reduction in bone mineral content (osteopenia). It is a problem faced by very low birth weight (VLBW) infants because of lack of fetal mineralization during the last trimester. Our aim was to assess serum alkaline phosphatase (ALP) level as an early biomarker for osteopenia in premature infants and to estimate an optimal cutoff value of serum ALP at which osteopenia is detected radiologically in premature newborns.