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Plasma alkaline phosphatase activity in the preterm neonate
Insights
Preterm infants often show elevated alkaline phosphatase, indicating bone activity, even without rickets. This bone enzyme increase may reflect normal development during the third trimester and early newborn period.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Biochemistry
Background:
- Rickets is a significant concern in preterm infants.
- Vitamin D deficiency is a common cause of rickets.
- Monitoring bone metabolism in preterm infants is crucial.
Purpose of the Study:
- To investigate plasma alkaline phosphatase (ALP) activity in preterm infants.
- To determine the origin and significance of elevated ALP in this population.
- To differentiate physiological bone activity from pathological rickets.
Main Methods:
- Clinical and radiological diagnosis of rickets.
- Serial biochemical monitoring of preterm infants.
- Measurement of plasma alkaline phosphatase activity.
- Determination of ALP origin (bony).
Main Results:
- One preterm infant diagnosed with rickets despite vitamin D therapy died.
- Four control preterm infants showed a transient increase in plasma ALP, peaking around term-equivalent age.
- Elevated ALP was of bony origin in all infants studied.
- Radiological rickets confirmed in only one of the four control infants.
Conclusions:
- Markedly elevated plasma ALP is common in preterm infants.
- This elevation may represent physiological osteoblastic activity and bone mineralization.
- It reflects normal bone development during the third trimester and early neonatal period.
Abstract:
Rickets was diagnosed clinically and confirmed radiologically in a preterm infant at 12 weeks of age, who despite therapy with vitamin D died. Four preterm infants who were subsequently admitted to the nursery had their biochemistry followed serially as controls. All infants demonstrated a marked increase and then subsequent decrease in plasma alkaline phosphatase activity; the peak value occurring near to what should have been gestationally term. The plasma alkaline phosphatase was of bony origin. Rickets was confirmed radiologically in only one of these four infants. Rising and markedly elevated plasma alkaline phosphatase activity appears to be common in this group of infants and may represent a physiological increase in osteoblastic activity and increasing bone mineralisation in what would have been the infants' 3rd trimester of pregnancy and immediate newborn period.