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Metabolic bone disease of prematurity and secondary hyperparathyroidism

Ashish Lothe1, John Sinn, Monique Stone

  • 1Department of Neonatology, Royal North Shore Hospital The University of Sydney, Sydney, New South Wales, Australia.

Journal of Paediatrics and Child Health
|March 12, 2011
PubMed

Insights

Early diagnosis of metabolic bone disease (MBD) in premature infants is crucial. Laboratory tests like alkaline phosphatase and parathyroid hormone (PTH) aid in managing MBD, even with normal calcium and phosphate levels.

Area of Science:

  • Neonatology
  • Pediatric Endocrinology
  • Biochemistry

Background:

  • Metabolic bone disease (MBD) poses a significant risk to extremely premature infants.
  • Prematurity, low birth weight, and feeding intolerance are key risk factors for MBD.

Observation:

  • Three cases of extreme premature infants with MBD are presented.
  • Risk factors included very low birth weight, delayed enteral feeds, cholestatic liver disease, and medication use.
  • Elevated serum alkaline phosphatase and parathyroid hormone (PTH) were noted despite normal calcium and phosphate levels.

Findings:

  • MBD in premature infants leads to significant calcium and phosphate depletion.
  • Normal serum calcium and phosphate may mask inadequate intake or stores due to PTH.
  • Supplementation with calcium, phosphate, and vitamin D corrected MBD parameters.

Implications:

  • Routine laboratory monitoring of alkaline phosphatase, vitamin D, and PTH is recommended for at-risk infants.
  • Early diagnosis and management of MBD are essential for optimal infant outcomes.
  • Understanding the role of PTH in masking MBD is critical for clinical practice.
Abstract

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