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Plasma alkaline phosphatase activity and its relation to rickets in pre-term infants
Insights
High plasma alkaline phosphatase activity in preterm infants may indicate subclinical bone disease, even without rickets evidence. Monitoring this enzyme activity is crucial for assessing bone health in premature neonates.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Biochemistry
Background:
- Plasma alkaline phosphatase (ALP) activity is a marker of bone turnover.
- Premature infants are at risk for various metabolic bone diseases.
- Understanding ALP dynamics in preterm infants is essential for early diagnosis.
Purpose of the Study:
- To investigate the pattern of plasma alkaline phosphatase activity in preterm infants.
- To determine the correlation between elevated ALP levels and radiological evidence of rickets.
- To assess the significance of high ALP activity as a potential indicator of subclinical bone disease.
Main Methods:
- Sequential plasma ALP activity measurements were performed in 84 preterm infants (<38 weeks gestation).
- Infants were monitored for changes in ALP levels over time.
- Radiological assessments were conducted to identify evidence of rickets.
- ALP levels were compared to adult reference ranges and correlated with clinical findings.
Main Results:
- In 67% of infants, ALP activity peaked and then declined, often without radiological rickets.
- In most cases, peak ALP levels did not exceed 10 times the adult reference range.
- Three infants showed radiological evidence of rickets.
- Six infants had higher ALP levels, with only one exhibiting radiological rickets, suggesting subclinical bone disease in the others.
Conclusions:
- Elevated plasma alkaline phosphatase activity in preterm infants can be a sign of subclinical bone disease, even in the absence of overt rickets.
- Monitoring ALP levels is recommended for assessing bone health in this vulnerable population.
- Further investigation into the causes and implications of subclinical bone disease in preterm infants is warranted.
Abstract:
Sequential measurements of plasma alkaline phosphatase activity were made in 84 pre-term infants delivered before 38 weeks gestation. In 67% of infants, without evidence of rickets but in whom three or more measurements were made and the peak activity was less than 10 times the adult reference range, the activity rose to a peak and declined to previous levels, or lower. The time taken for these changes varied greatly. The range of values was inspected at each week of age, and in all but six cases the level did not exceed 10 times the upper limit of the adult reference range. Three infants had radiological evidence of rickets, and of the six cases in whom higher levels were found, only one had radiological evidence of rickets; the remainder did not. It is recommended that in the latter, the high plasma alkaline phosphatase activity should be regarded as evidence of subclinical bone disease.