[Osteopenia of prematurity. Proposal for clinical-laboratory screening]
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E Zecca1, C Romagnoli, M C Alecci
1Istituto di Clinica Pediatrica, Policlinico Universitario A. Gemelli, Roma.
Insights
Osteopenia in preterm infants can be identified by wider anterior fontanelles and rising alkaline phosphatase. This study suggests a clinical and biochemical score for diagnosing and monitoring osteopenia, reducing X-ray exposure.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Radiology
Background:
- Osteopenia is a common metabolic bone disease in preterm infants.
- Current diagnosis and follow-up rely heavily on X-ray evaluations.
- Identifying specific clinical and biochemical markers is crucial for early detection.
Purpose of the Study:
- To identify distinct clinical and biochemical features of osteopenia in preterm infants.
- To develop a scoring system for diagnosing and monitoring osteopenia.
- To reduce unnecessary X-ray exposure in non-osteopenic infants.
Main Methods:
- Prospective study of 77 preterm infants (birth weight < 2500g).
- Clinical, biochemical, and radiological assessments every 2 weeks from 2 to 12 weeks of life.
- Comparison between osteopenic infants and control groups based on gestational age and birth weight.
Main Results:
- Wider anterior fontanelles with increasing dimensions and craniotabes (ping pong ball sign) were characteristic of osteopenic infants.
- Progressively increasing alkaline phosphatase activity was observed in osteopenic babies.
- Gestational age <= 32 weeks and/or birth weight <= 1500 grams were associated with higher risk.
Conclusions:
- Specific clinical signs (fontanelle changes) and biochemical markers (alkaline phosphatase) aid in diagnosing osteopenia in preterm infants.
- A proposed clinical and biochemical score can facilitate accurate diagnosis and non-invasive follow-up.
- This approach can minimize radiation exposure from X-rays in vulnerable infants.
Abstract:
Osteopenia is a metabolic bone disease which affects a great deal of preterm infants. X-Ray evaluation is still the main step of the diagnostic and follow-up procedures. The Authors prospectively studied 77 newborn infants with birth weight less than 2500 grams, to identify specific clinical and biochemical features of the osteopenic infants. From the 2nd to the 12th week of life clinical, biochemical and radiological signs of osteopenia were looked for, every 2 weeks: the diagnosis of osteopenia was made on the basis of X-Ray. 26 osteopenic subjects with ga less than or equal to 32 weeks and/or bw less than or equal to 1500 grams were compared with 20 controls with ga less than or equal to 32 weeks and/or bw less than or equal to 1500 grams and with 31 control infants with ga greater than 32 weeks and bw greater than 1500 grams. Wider anterior funtanels, their progressively increasing dimensions, and craniotabe (with the "ping pong ball" sign) were the most characteristic features, as well as the increasing pattern of alkaline phosphatase activity, of the osteopenic babies. The Authors suggest a specific clinical and biochemical score to make the correct diagnosis and a non invasive follow-up in the osteopenic subjects and to avoid dangerous X-Ray exposure to babies that are not osteopenic.