Procollagen type I N-terminal peptide in preterm infants is associated with growth during the first six months
Monique van de Lagemaat1, Eveline van der Veer, Mirjam M van Weissenbruch
1Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
Insights
Small-for-gestational-age (SGA) preterm infants show increased growth and collagen type I synthesis, indicated by procollagen type I N-terminal peptide (PINP), compared to appropriate-for-gestational-age (AGA) infants. This suggests PINP and urinary helical peptide (UHP) track growth in preterm infants.
Area of Science:
- Neonatal physiology
- Pediatric endocrinology
- Biochemistry
Background:
- Preterm infants, particularly those small-for-gestational-age (SGA), face challenges in growth and bone acquisition post-term.
- Understanding growth markers in SGA preterm infants is crucial for optimizing their development.
Purpose of the Study:
- To identify collagen and bone parameters related to growth in SGA versus appropriate-for-gestational-age (AGA) preterm infants during the first six months post-term.
- To investigate if markers reflect previously observed increased growth and decreased bone acquisition in SGA infants.
Main Methods:
- Observational study within a randomized controlled trial.
- Included 33 SGA and 98 AGA preterm infants.
- Measured weight, length, procollagen type I N-terminal peptide (PINP), urinary helical peptide (UHP), and alkaline phosphatase (ALP) expressed as standard deviation scores (SDS) at term, 3, and 6 months post-term.
Main Results:
- SGA infants exhibited higher weight and length gain, and higher PINP SDS at term, 3, and 6 months compared to AGA infants.
- Urinary helical peptide (UHP) SDS and alkaline phosphatase (ALP) SDS were similar between SGA and AGA groups.
- PINP and UHP SDS at term, and PINP SDS at 3 months, correlated with subsequent weight and length gain up to 6 months post-term.
Conclusions:
- Increased growth in SGA preterm infants is associated with heightened collagen type I synthesis, as indicated by PINP and UHP.
- These findings suggest PINP and UHP are reliable indicators of growth in preterm infants.
- The discrepancy between increased collagen synthesis and bone acquisition in SGA infants may point to impaired bone mineralization.
Objective:
To identify growth-related collagen and bone parameters in small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants during the first six months post-term. In SGA preterm infants, increased growth and decreased bone acquisition, which we demonstrated previously, may be reflected by these markers.
Design:
Observational study within a randomized controlled trial.
Patients:
Thirty-three SGA (weight, length or both at birth <-2 SDS) and 98 AGA preterm infants (gestational age [median (IQR)]: 31·1 (1·6) vs 30·3 (2·0) weeks; 72·7% vs 42·9% boys).
Measurements:
Weight (g), length (cm), procollagen type I N-terminal peptide (PINP; μg/l), urinary helical peptide (UHP; μg/mmol creatinine) and alkaline phosphatase (ALP; U/l) expressed as standard deviation scores (SDS) at term age, three and six months post-term.
Results:
Weight and length gain during the first six months post-term and PINP SDS at term age, three months and six months post-term were higher in SGA compared with AGA infants. UHP SDS and ALP SDS were similar in SGA and AGA infants. PINP SDS and UHP SDS at term age and PINP SDS at three months were associated with subsequent weight and length gain until six months post-term.
Conclusions:
Increased growth in SGA compared with AGA preterm infants is reflected by increased collagen type I synthesis during the first six months post-term, suggesting that PINP and UHP correspond with growth in preterm infants. An explanation for decreased bone acquisition of SGA preterm infants may be that increased collagen type I synthesis is not directly followed by increased bone mineralization.
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