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Metabolic bone disease in preterm infants: Relationship between radiologic grading in the wrist and serum biochemical
1Department of Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea.
Insights
This study found that alkaline phosphatase (ALP) levels around 6.9 weeks after birth, combined with wrist radiography, can help screen for metabolic bone disease (MBD) in preterm infants. This approach aids in early detection of MBD, excluding cases with suspected fractures.
Area of Science:
- Neonatal Medicine
- Pediatric Radiology
- Biochemistry
Background:
- Metabolic bone disease (MBD) is a significant concern in preterm infants.
- Early detection and management of MBD are crucial for optimal infant outcomes.
- Radiographic findings and biochemical markers are key indicators for MBD diagnosis.
Purpose of the Study:
- To investigate the correlation between radiographic evidence of MBD and serum biochemical marker levels in preterm neonates.
- To identify reliable biochemical markers for MBD screening in this vulnerable population.
Main Methods:
- A cohort of 159 preterm infants was analyzed.
- Wrist radiography was performed and graded for MBD severity by two independent readers.
- Serum alkaline phosphatase (ALP) and phosphorous (P) levels were measured at various time points: immediately after birth, on the day of radiography, before radiography, and during follow-up.
Main Results:
- Significant differences in ALP and P levels were observed between different MBD severity grades and between infants with and without MBD (P<0.001).
- Follow-up ALP levels (ALP-h) demonstrated the highest predictive value (AUC=0.752) for MBD.
- An optimal ALP-h cut-off of 473.5 U/L was identified, with 81.5% sensitivity and 47.9% specificity, measured at a mean of 6.9 weeks post-birth.
Conclusions:
- Combining wrist radiography with serum ALP levels measured around 6.9 weeks post-birth is a valuable screening strategy for MBD in preterm infants.
- This combined approach can aid in early MBD detection, particularly when fractures are not clinically suspected.
Purpose:
To assess the relationship between radiographic findings of metabolic bone disease (MBD) and serum biochemical markers in preterm infants.
Materials And Methods:
A total of 159 preterm infants were included in this study. Two readers reviewed the wrist radiography for grading according to MBD severity. We recorded the levels of alkaline phosphatase (ALP) and phosphorous (P) immediately after birth, on the same day of the first wrist radiography (ALP-s, P-s), the highest/lowest ALP/P levels before the first wrist radiography (ALP-hb/P-lb) and during follow-up (ALP-h/P-l). For analysis, the patients were first subdivided into 4 groups according to MBD severity, and were then divided into 2 groups according to MBD presence or absence.
Results:
Of the 159 patients, 94, 39, 19, and 7 infants were classified into grades 0,1, 2, and 3. Analysis according to severity showed that ALP-s, ALP-hb, and ALP-h differed between grades 0-1 and 2-3 (all P<0.001); P-lb differed between grades 0 and 2 (P=0.001); and P-l differed between grades 0 and 2 or 3 (P<0.001 or P=0.001). Moreover, ALP-s, ALP-hb, ALP-h, P-s, P-lb, and P-l differed according to the presence or absence of MBD (P<0.001). ALP-h showed the largest area under the curve value (0.752, 95% confidence interval=0.676-0.828, P<0.001). The optimal cut-off value of ALP-h was 473.5U/L. The sensitivity and specificity were 81.5% and 47.9%. ALP-h was measured at 6.9±5.3 weeks after birth.
Conclusion:
Taking the wrist radiography with reference to an ALP level measured at around 6.9 weeks after birth could be helpful for screening of MBD in preterm infants, unless a fracture is clinically suspected.
