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Published on: January 29, 2018
Metabolic bone disease and bone mineral density in very preterm infants
Josep Figueras-Aloy1, Enriqueta Álvarez-Domínguez1, José M Pérez-Fernández1
1Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
Insights
A bone mineral density (BMD) greater than 0.068 g/cm(2) at discharge suggests preterm neonates will likely not develop metabolic bone disease. Higher birth weight and shorter parenteral nutrition duration are linked to better bone health.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Radiology
Background:
- Metabolic bone disease of prematurity (MBDP) is a common complication in very low birth weight infants.
- Early diagnosis and management are crucial to prevent long-term skeletal complications.
Purpose of the Study:
- To establish bone mineral density (BMD) reference values in preterm neonates at discharge.
- To identify optimal serum alkaline phosphatase (ALP) and phosphorus (P) cutoff values for diagnosing MBDP severity.
- To determine factors associated with improved BMD in preterm infants.
Main Methods:
- Prospective evaluation of 336 preterm neonates (≤ 31 weeks gestation, ≤ 1500 g birth weight) using dual-energy X-ray absorptiometry for BMD assessment before discharge.
- Serum ALP and P levels were analyzed to categorize MBDP severity.
Main Results:
- BMD reference values were established (e.g., poor BMD <0.068 g/cm(2)).
- MBDP was absent in 83.0% (ALP ≤ 500 IU/L), mild in 13.7% (ALP >500 IU/L, P ≥ 4.5 mg/dL), and severe in 3.3% (ALP >500 IU/L, P <4.5 mg/dL).
- Higher birth weight, shorter parenteral nutrition, and absence of specific clinical conditions were associated with increased BMD.
Conclusions:
- A BMD >0.068 g/cm(2) at discharge predicted a 90.3% probability of not developing MBDP.
- Factors promoting better BMD included higher birth weight, limited parenteral nutrition, absence of intraventricular hemorrhage, fortified breast milk feeding, and older discharge age.
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.
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