Incidence, Risk Factors and Prediction of Secondary Hyperparathyroidism in Preterm Neonates under 32 Weeks'...

Area of Science:

• Neonatology
• Pediatric Endocrinology
• Metabolic Bone Disease

Background:

• Secondary hyperparathyroidism (HPTH) is frequently underdiagnosed in preterm newborns.
• Early identification of HPTH is crucial for guiding nutritional management in infants with metabolic bone mineral disease (MBD).

Purpose of the Study:

• To determine the incidence of HPTH in very premature infants (≤32 weeks gestational age).
• To identify risk factors, associated morbidities, and biochemical alterations related to HPTH.
• To develop and evaluate a predictive model for HPTH in this population.

Main Methods:

• Retrospective cohort study including 154 preterm infants.
• Analysis of risk factors including delivery method, respiratory support, and anemia.
• Evaluation of biochemical markers such as serum calcium, phosphate, vitamin D, and urinary calcium/creatinine ratio.
• Development of a predictive model using gestational age and urinary calcium/creatinine ratio.

Main Results:

• The incidence of HPTH was 40.3% in the studied cohort.
• Independent risk factors included cesarean section, oxygen during resuscitation, invasive mechanical ventilation, and anemia requiring transfusion.
• Serum phosphate, lower serum calcium, lower vitamin D, and lower urinary calcium/creatinine ratio were associated with HPTH.
• A predictive model incorporating gestational age and urinary calcium/creatinine ratio achieved an AUC of 0.828.

Conclusions:

• HPTH is a common condition in very premature infants.
• Further research is needed to clarify the role of HPTH in MBD and the clinical utility of predictive models for management.