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Reference values of parathyroid hormone in very low birth weight infants
Tomas Matejek1, Bara Zapletalova1, Jaroslav Stranik2
1Department of Paediatrics, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
Insights
This study established normal parathyroid hormone (PTH) levels in very low birth weight infants, finding a range of 0.9-11.9 pmol/l. Elevated PTH may indicate hyperparathyroidism in these vulnerable neonates.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Biochemistry
Background:
- Very low birth weight (VLBW) infants are susceptible to metabolic disturbances.
- Parathyroid hormone (PTH) plays a crucial role in calcium and phosphorus homeostasis.
- Establishing reference ranges for PTH is essential for diagnosing and managing bone metabolism disorders in neonates.
Purpose of the Study:
- To determine reference values for serum parathyroid hormone (PTH) in very low birth weight infants without significant neonatal complications.
- To investigate the association between PTH levels and markers of bone metabolism, including 25-hydroxyvitamin-D (25(OH)D).
Main Methods:
- Serum PTH, 25(OH)D, calcium, phosphorus, and alkaline phosphatase were measured in 92 VLBW infants.
- Urinary calcium, phosphorus, and creatinine were also analyzed.
- Measurements were taken on day 14 and bi-weekly until discharge.
Main Results:
- The estimated physiological PTH range in VLBW infants without 25(OH)D deficiency was 0.9-11.9 pmol/l (8.5-112.3 pg/mL).
- No significant correlation between PTH and bone metabolism markers was found in the first month.
- From the second month, significant correlations emerged between PTH and 25(OH)D, and PTH and calcium/phosphorus ratios.
Conclusions:
- The established PTH range of 0.9-11.9 pmol/l serves as a reference for VLBW neonates without 25(OH)D deficiency.
- Serum PTH elevation above this range suggests potential hyperparathyroidism in this population.
- These findings aid in the clinical management of bone health in preterm infants.
Purpose:
The primary goal was to estimate reference values of parathyroid hormone (PTH) in very low birth weight infants without severe neonatal morbidity. A secondary objective was to assess the relationship between PTH serum levels and selected laboratory markers of bone metabolism.
Methods:
Ninety two infants with birth weight less than 1500 g met the inclusion criteria of the study. Serum levels of PTH, 25-hydroxyvitamin-D [25(OH)D], C3-epi-25(OH)D, total calcium, phosphorus, and alkaline phosphatase, and urinary levels of calcium, phosphorus, and creatinine were examined on day 14 and subsequently every 2 weeks until discharge.
Results:
Of the total 167 serum samples examined for PTH levels in infants without 25(OH)D deficiency the estimated range was 0.9-11.9 pmol/l (8.5-112.3 pg/mL). During the first month, no statistically significant correlation was observed between PTH level and that of 25(OH)D, C3-epimers of 25(OH)D, S-Ca, S-P, or ALP, nor with urinary excretion of calcium and phosphorus. From the second month of life, there was a moderately significant correlation between PTH and 25(OH)D (Rho = -0.40, P =< .001), between PTH and calcium/creatinine ratio (Rho = -0.56, P = < .001), and between PTH and phosphorus/creatinine ratio (Rho = 0.51, P = < .001).
Conclusions:
The physiological range for PTH levels for preterm neonates without 25(OH)D deficiency was estimated as 0.9-11.9 pmol/l (8.5-112.3 pg/mL). It seems that elevation of serum PTH above this range can be considered as hyperparathyroidism in very low birth weight infants.
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