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Is quantitative ultrasound a measure for metabolic bone disease in preterm-born infants? A prospective subcohort
A de Lange1, J M Maaskant2, M M van Weissenbruch3
1Division of Neonatology, Department of Pediatrics, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands. annemieke.delange@amsterdamumc.nl.
Insights
Bone development in preterm infants shows a continued decrease in metacarpal speed of sound (mcSOS) and a plateau in metacarpal bone transmission time (mcBTT) up to 24 months, influenced by growth parameters.
Area of Science:
- Pediatrics
- Neonatology
- Orthopedics
Background:
- Preterm birth can lead to long-term adverse outcomes, including metabolic bone disease.
- Metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT) are known to decline in the early postnatal period for preterm infants.
Purpose of the Study:
- To evaluate postnatal bone development changes in relation to growth in preterm infants from birth to 24 months corrected age.
- To identify factors associated with bone development during this period.
Main Methods:
- Utilized metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT) to assess bone development in 98 preterm infants.
- Data collected during hospitalization and follow-up until 24 months corrected age.
Main Results:
- mcSOS declined during hospitalization and continued to decrease, reaching its lowest point at 12 months.
- mcBTT also declined initially but reached a plateau between 12 and 24 months corrected age.
- Growth parameters, including weight and length, were significant factors associated with both mcSOS and mcBTT.
Conclusions:
- Metacarpal speed of sound (mcSOS) decreases up to 12 months, and metacarpal bone transmission time (mcBTT) plateaus by 24 months in preterm infants.
- Growth parameters significantly influence bone development markers (mcSOS and mcBTT) in this population.
- Optimal mineralization rates may not be achieved due to postnatal nutrition and comorbidities.
Abstract:
In this study, we aimed to (a) evaluate postnatal changes in bone development in relation to growth and (b) to determine factors associated with bone development, from birth to 24 months of corrected age. The metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT) were used to evaluate bone development in 98 preterm infants, during hospitalization and follow-up. The mcSOS and mcBTT values not only declined in the first 6 weeks of hospitalization but also during follow-up. The mcSOS reached its lowest point at 12 months (β=-34.64), while the mcBTT reached a plateau between 12 and 24 months (β=0.06). Univariable analysis showed that gender (p=0.28), time (p<0.001), and growth parameters (p<0.001) were significant negative associated factors with mcSOS, whereas with mcBTT, time (p=0.009), length (p=0.063), length standard deviation scores (SDS) (p=0.027), head circumference (p=0.005), and head circumference SDS (p=0.007) were significant positive. The multivariable model revealed that time (β= -3.364, p=<0.001), weight (β=-0.007, p<0.001) and length (β=1.163, p<0.001) for mcSOS and length (β=-0.021, p<0.001), and length SDS (β= 0.066, p<0.001) and head circumference (β=0.049, p<0.001) for mcBTT remained highly significant associated factors.Conclusion: The most important finding is that mcSOS decreased and the mcBTT reached a plateau to 24 months. In both mcSOS and mcBTT, the growth parameters were significant factors.Clinical Trial Registration: N/A What is known: • Metabolic bone disease is one of the possible long term adverse outcomes after preterm birth. • Metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT) decline in the early postnatal period. What is new: • During follow-up, mcSOS further decreased and reached its lowest point at 12 months, while the mcBTT reached a plateau up to 24 months. • Postnatal nutrition in relation to comorbidity does not meet the optimal mineralization rate of the developing preterm bone.
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