Metabolic bone disease in preterm babies: are we underestimating it?” (original) (raw)
Related papers
Metabolic Bone Disease In Premature Neonates- An Unmet Challenge
Journal of Clinical Research in Pediatric Endocrinology
The metabolic bone disease is an important morbidity in premature, very low birth weight and sick infants. If left undiagnosed, leads to structural deformities & spontaneous fractures.It is defined as impaired bone mineralization in a neonate with lower than the estimated bone mineral levels in either fetus or neonate of comparable gestational age / weight coupled with biochemical abnormalities with or without radiological manifestations. It has been reported to occur in 16% to 40% of extremely low birth weight neonates. Insufficient calcium and phosphorous stores during the phase of accelerated growth predispose to it along with use of medications (caffeine, steroids), prolonged parenteral nutrition & chronic immobilization. It presents by 6-16 weeks after birth. Enhanced physical activity in preterm infants facilitates bone mineralization and weight gain. Biochemical abnormalities tend to worsen significantly, as the severity of disease progresses. They consist of hypocalcemia, hypophosphatemia, hyperphosphatasia and secondary hyperparathyroidism. In addition, urinary phosphate wasting and hypo vitaminosis D can complicate these abnormalities. Conversely, biochemical abnormalities may not be accompanied by rachitic changes. Newer diagnostic modalities include bone densitometry by quantitative ultrasound over mid-tibial shaft (noninvasive tool). The management of metabolic bone disease includes adequate calcium, phosphorous and vitamin D supplementation along with optimum nutrition and physical activity. Similarly, preventive strategies for metabolic bone disease should target nutritional enhancement alongside enhanced physical activity. Conclusion: Metabolic bone disease is a preventable morbidity in preterm, VLBW neonates and requires optimum nutritional supplementation and enhanced physical activity.
Metabolic Bone Disease and Bone Mineral Density in Very Preterm Infants
The Journal of Pediatrics, 2014
Objectives To evaluate bone mineral density (BMD) in preterm neonates at discharge and identify the optimum cutoff values for serum alkaline phosphatase (ALP) and phosphorus (P) concentrations to diagnose the severity of metabolic bone disease of prematurity. Study design A total of 336 preterm neonates (#31 weeks' gestation and birth weight #1500 g) were prospectively evaluated for BMD before discharge using dual-energy X-ray absorptiometry. Results BMD reference values (at ALP #500 IU/L) were measured in 279 patients. BMD was classified as poor (<10th percentile) at <0.068 g/cm 2 , fair (10th-25th percentile) at 0.068-0.081 g/cm 2 , good (25th-75th percentile) at 0.081-0.112 g/cm 2 , and very good (>75th percentile) at >0.112 g/cm 2. Increased BMD was associated with a higher birth weight, short duration of parenteral nutrition, and the absence of small for gestational age status, patent ductus arteriosus, intraventricular hemorrhage, and other clinical variables. Metabolic bone disease of prematurity was absent (ALP #500 IU/L) in 279 cases (83.0%), mild (ALP >500 IU/L and P $4.5 mg/dL) in 46 cases (13.7%), and severe (ALP >500 IU/L and P <4.5 mg/dL) in 11 cases (3.3%). Conclusions A BMD >0.068 g/cm 2 at discharge indicated a 90.3% probability of not developing metabolic bone disease of prematurity. The factors independently associated with increased BMD included higher birth weight, short duration of parenteral nutrition, absence of intraventricular hemorrhage, exclusive feeding of fortified breast milk, and older age at discharge.
Metabolic Bone Disease of Prematurity: Risk Factors and Associated Short-Term Outcomes
Nutrients, 2020
Despite the importance of early recognition of metabolic bone disease (MBD) of prematurity, there is still significant variability in screening practices across institutions. We conducted an observational study of infants born at ≤32 weeks of gestation with a birth weight of ≤1500 g (n = 218) to identify clinical factors associated with biochemical indicators of MBD. Bone mineral status was assessed by measuring alkaline phosphatase and phosphate levels between weeks 3 and 5 of life. Two comparisons were performed after classifying infants as either MBD (cases) or non-MBD (controls), and as either high or low risk for MBD, as determined based on the results of MBD screening. In total, 27 infants (12.3%) were classified as cases and 96 (44%) as high-risk. Compared with controls, MBD infants had a significantly lower gestational age and birth weight, and a longer duration of parenteral nutrition and hospital stay. Respiratory outcomes were significantly poorer in high- versus low-risk...
Metabolic Bone Disease in Very Low-Birth-Weight Neonates
Iranian Journal of Neonatology IJN, 2015
Background: Metabolic bone diseases (MBD), including rickets and osteopenia, are important neonatal complications among preterm infants. This study aimed to determine the prevalence and risk factors of MBD in neonates with very low birth weight (VLBW). Methods: This prospective study was conducted on VLBW infants from January 2012 to July 2013. Inclusion criteria were birth weight of ≤1500 g and age of ≤7 days, and the exclusion criteria were cholestatic disorders, skeletal anomalies and genetic syndromes. Serum calcium, phosphorus and alkaline phosphatase (ALP) concentrations were measured regularly until the 12th week of birth. In addition, wrist and chest radiographs were obtained from the neonates at 8-12 weeks of age. Results: In total, 58 neonates with the mean gestational age of 30.6±2.65 weeks, weight of 1265±262 g and height of 38.06±2.49 cm were enrolled in this study. The correlation between biochemical parameters in multiple analysis and radiological findings of rickets ...
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 ...
Outcomes of standardised approach to metabolic bone disease of prematurity
Journal of paediatrics and child health, 2018
To assess the current protocol of metabolic bone disease (MBD) at three Monash Health neonatal units (Melbourne, Australia). Retrospective audit of 171 infants born at <32 weeks' gestation over 18 months. Mean gestational age was 28.6 ± 2.1 weeks, and birthweight was 1190 ± 374 g. Risk factors of MBD include intra-uterine growth retardation (n = 33, 19.3%), maternal pre-eclampsia (n = 17, 9.9%), necrotising enterocolitis (n = 9, 5.4%) and medications like methylxanthines (94.2%; mean 54.8 days), diuretics (38.6%; mean 49.2 days) and glucocorticoids (5.3%; mean 35 days). In total, 84.8% infants had an initial MBD screen (mean age 36.3 days), with 45% having repeated monitoring (mean age 71.9 days), and 14.2% had initial alkaline phosphatase levels >500 U/L, decreasing to 10.1% on follow-up. All infants received additional vitamin D supplementation of 400 IU/day, phosphate of 25.1% (n = 43) and calcium of 19.9% (n = 34). Fractures were identified from clinical documentation ...
Metabolic Bone Disease of Prematurity: Report of Four Cases
Journal of Clinical Research in Pediatric Endocrinology, 2014
This 85-day-old female infant was referred to our clinic because of elevated serum alkaline phosphatase (ALP) levels. She was delivered in the 31 st gestational week with a birth
Journal of Parenteral and Enteral Nutrition, 2013
Premature infants are at increased risk for metabolic bone disease, with resulting delayed bone growth, osteopenia, and rickets. A systematic review of the best available evidence to answer a series of questions regarding neonatal patients at risk of metabolic bone disease receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. (1) What maternal risk factors predispose the neonate to metabolic bone disease? (2) What is the optimal type of feeding to promote neonatal bone health? (3) When and how should vitamin D supplements be administered? (4) Does parenteral nutrition (PN) predispose a neonate to metabolic bone disease, and if so, are there PN formulation recommendations to minimize this risk?
Global Journal of Health Science, 2015
Introduction: Bone metabolic disease is an important issue in newborns with very low birth weight. The 80 percent of the transport of calcium (Ca) and phosphor (P) from mother to fetus takes place in the third trimester of pregnancy. This transport process is impaired with the preterm delivery of the newborn. On the other side, breast milk and formula are not competent resources to supply sufficient amounts of Ca and P to meet the requirements of the preterm newborn, thereby a greater reduction in the storage of these minerals. The current study has been done with the purpose of comparing the effects of two feeding methods on the indices of metabolic bone disease in newborns with very low birth weights (VLBW). Materials and Methods: The study design was cohort and the study was done on a total of 58 newborns with very low birth weights in Kashan Shahid Beheshti Hospital. The newborns were divided into two groups with 29 placed in the group of alternate feeding on preterm formula (preNan) and the other 29 placed in the group of breast milk and preterm formula (preNan). Eventually, the indices of bone metabolic disease were measured in both groups and were statistically analyzed. Results: The difference between the mean serum levels of Ca in different weeks and also between the two groups were significant (p=0.001). However, the changes in mean serum level of P in the two groups were not significant (P=0.151). The comparison of serum levels of alkaline phosphatase between the two groups indicated that their difference was significant and that they had been influenced by the feeding method (P=0.001). The serum level of bicarbonate, when compared between the two groups, was found to make a significant difference (P=0.001). The difference between the two feeding methods in precipitating rickets and osteopenia was not significant. Conclusion: According to the findings of current study, feeding on preterm formula (preNan) is associated with better and more desirable results, though the occurrence of rickets in the two groups had no significant difference.
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 ...