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Skeletal changes in preterm infants
Insights
Very low birthweight infants receiving vitamin D supplements can still develop rickets. Skeletal demineralization and rickets were observed in some infants, indicating unknown causes for these bone issues.
Area of Science:
- Neonatalogy
- Pediatric Radiology
- Biochemistry
Background:
- Very low birthweight (VLBW) infants are susceptible to skeletal complications.
- Rickets is a concern in VLBW infants, even with vitamin D supplementation.
Purpose of the Study:
- To investigate skeletal changes in VLBW infants.
- To identify risk factors associated with skeletal demineralization and rickets in VLBW infants.
Main Methods:
- Clinical, biochemical, and radiological assessments were performed on 19 VLBW infants from birth to 10 weeks.
- Infants received 800 IU of vitamin D daily from 2 weeks of age.
- Radiographs were analyzed for signs of skeletal demineralization and rickets.
Main Results:
- Six infants showed radiological evidence of skeletal demineralization; one had severe rickets, and another had rickets with fractures.
- Infants with abnormal radiographs had shorter gestational periods, lower birthweights, more clinical problems, and delayed feeding progression.
- Higher serum alkaline phosphatase levels were noted at 5 weeks in infants with abnormal radiographs.
Conclusions:
- Skeletal demineralization and rickets can occur in VLBW infants despite vitamin D supplementation.
- Lower birthweight and gestational age are associated with increased risk of skeletal lesions.
- The exact cause of skeletal lesions in VLBW infants remains undetermined.
Abstract:
The skeletal changes in 19 very low birthweight infants (less than 1500 g) were observed from birth to 10 weeks, by means of clinical, biochemical, and radiological techniques. All infants were receiving a supplement of 800 IU vitamin D a day from age 2 weeks. None of the infants showed any specific physical sign of rickets during the period of study. Six infants showed radiological evidence of skeletal demineralisation; 1 of these had severe changes of rickets and 1 had both rickets and fractures. These 6 infants were of shorter gestational periods and lower birthweights than the infants not showing radiological changes. They tended to have more clinical problems and to reach a predetermined volume of feeds (160 ml/kg a day) later than the unaffected infants. Serum alkaline phosphatase values were significantly higher at 5 weeks in the infants with abnormal radiographs than in those without. There were no significant differences between the two groups in relation to serum calcium, inorganic phosphate, 25 hydroxyvitamin D, and immunoreactive parathyroid hormone. The pathogenesis of the skeletal lesions of very low birthweight infants remains unknown.