Decreased Bone Ultrasound Velocity in Large-for-Gestational-Age Infants

Littner, Yoav; Mandel, Dror; Mimouni, Francis; Dollberg, Shaul

doi:10.1038/sj.jp.7211013

Cited by 23 publications

(20 citation statements)

References 20 publications

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“…Our data also confirm previous studies that reported a correlation of bone quality with gestational age and birth weight both by DXA [23][24][25][26] and QUS. [9][10][11][12][13][14][15]27,28 Multivariate analysis confirmed postconceptional age as the most relevant predictor of bone quality. Body weight was the strongest predictor of QUS in the most immature infants but lost its significance in term neonates.…”

Section: Discussionmentioning

confidence: 90%

Ultrasound for the assessment of bone quality in preterm and term infants

Rack

Janni

et al. 2011

J Perinatol

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Objective: As 80% of intrauterine bone mineralization takes place during the last trimester of pregnancy, preterm infants should be supplemented postnatally with optimal doses of calcium, phosphate and vitamin D. Calcium and phosphate excretion in the urine may be used to monitor individual mineral requirements, but are sometimes difficult to interpret. The objective of this study was to assess the value of quantitative ultrasound (QUS) for the analysis of bone status in neonates.Study Design: All admissions to three independent tertiary neonatal intensive care units were studied. In 172 preterm and term infants with a gestational age between 23 and 42 weeks (mean 33.8 ± 5.0) and a birth weight from 405 to 5130 g (mean 2132±1091 g) bone status was evaluated prospectively by quantitative ultrasound velocity using a standardized protocol. Infants were followed in regular intervals up to their first discharge home. While measurements were conducted in weekly intervals initially (n ¼ 55), 2-week intervals were regarded as sufficient thereafter due to limited changes in QUS values within the shorter period. Infants with a birth weight below 1500 g were followed during outpatient visits until up to 17 months of age.Result: The intra-individual day-to-day reproducibility was 0.62%. QUSvalues from the first week of life correlated significantly with gestational age and birth weight (r ¼ 0.5 and r ¼ 0.6; P<0.001). Small-forgestational-age infants showed lower values for QUS than appropriate-forgestational-age infants allowing for their gestational age. Follow-up measurements correlated positively with age and weight during the week of measurement (r ¼ 0.2 and r ¼ 0.4; P ¼ 0.001). Comparing bone quality at 40 weeks of age in infants born at term versus infants born at 24 to 28 weeks, preterm infants showed significantly lower QUS than term infants (P<.0001).There was a significant correlation of QUS with serum alkaline phosphatase (P ¼ 0.003), the supplementation with calcium, phosphate and vitamin D (P< 0.001 each), as well as risk factors for a reduced bone mineralization. No correlation was found between QUS and calcium or phosphate concentration in serum or urine.Conclusion: QUS is a highly reproducible, easily applicable and radiation-free technique that can be used to monitor bone quality in individual newborns. Further prospective randomized-trials are necessary to evaluate, if therapeutic interventions based on QUS are able to prevent osteopenia of prematurity.

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Section: Discussionmentioning

confidence: 90%

Ultrasound for the assessment of bone quality in preterm and term infants

Rack

Janni

et al. 2011

J Perinatol

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“…Measurements of bone SOS were obtained on the right tibia as previously described. [11][12][13][14] Using this instrument at the tibial site, our coefficients of variation (within-measurement and between-measurements) was below 0.5%.…”

Section: Biophysical Methodsmentioning

confidence: 97%

Decreased neonatal tibial bone ultrasound velocity in term infants born after breech presentation

et al. 2007

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Objective: Fetuses found to be in the breech presentation have limited motion of their lower limbs. The aim of this study was to test the hypothesis that bone speed of sound (SOS) would be lower in infants born after breech presentation than in those born after vertex presentation.Study Design: We studied 127 singleton, appropriate for gestational age, term infants delivered by a scheduled cesarean delivery at approximately 38 weeks of gestation because of breech presentation or repeat elective cesarean section with vertex presentation. We used the Sunlight Omnisense 7000p device to measure axially transmitted SOS of the right tibia within the first 96 h of life.Result: Fifty-three infants studied (42%) were born by cesarean section after breech presentation compared to 74 vertex controls. Bone SOS was significantly lower in the breech presentation group, even after taking into account the effect of gender and parity (as well as gestational age at birth and birth weight).Conclusion: Bone SOS is lower in infants born after breech presentation than in those born after vertex presentation. We speculate that limited motion of lower limbs in fetuses found to be in the breech presentation leads to a decrease in bone mineralization and strength.

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“…A negative relationship between size at birth and bone SOS was also indicated by lower tibial SOS values in LGA infants compared with AGA infants of non-diabetic mothers. 30 The investigators speculated that the lower SOS values in the larger infants may be due to reduced intrauterine fetal mobility in the space-constrained in utero environment of the LGA infant. Reduced spontaneous activity reportedly contributes to lower postnatal tibial SOS values, 34 while daily physical activity programs attenuate the longitudinal postnatal decrease in SOS values 35 and promote greater gain in bone mineral density in VLBW infants.…”

Section: Discussionmentioning

confidence: 99%

“…[22][23][24][25][26][27][28] In contrast, a recent tibial QUS study reported that term and preterm SGA newborn infants had higher SOS values than AGA infants, 29 indicating greater bone strength in SGA infants. In addition, tibial SOS values are reportedly lower in newborn infants who are large-for-gestational age (LGA) 30 and in infants whose mothers had gestational diabetes, 31 further suggesting an inverse correlation between size at birth and bone SOS.…”

Section: Introductionmentioning

confidence: 99%

Bone ultrasound velocity in small- versus appropriate-for-gestational age preterm infants

2007

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Objective: To compare bone status of small-for-gestational age (SGA) versus appropriate-for-gestational age (AGA) newborn preterm infants.Study Design: Tibial speed of sound (SOS) was measured in 144 infants categorized as SGA or AGA using the reference tables of Lubchenco et al. and Alexander et al.Result: By the Lubchenco tables, 22% of infants were SGA and 75% were AGA. The mean gestational ages of SGA and AGA were similar (33.3±2.6 and 32.5±2.4 weeks, respectively, P ¼ 0.09); however, SGA infant birth weights were lower (1329±392 and 1829±481 g, respectively, P<0.001). SOS values were higher for SGA versus AGA infants (3098±135 and 3003±122 m/s, respectively. P<0.001). Use of the Alexander tables yielded a twofold increase in the percent of infants categorized as SGA; SOS values remained significantly greater for SGA infants (P<0.001). Conclusion:Higher tibial SOS values in SGA versus AGA infants indicate greater bone strength.

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Decreased Bone Ultrasound Velocity in Large-for-Gestational-Age Infants

Cited by 23 publications

References 20 publications

Ultrasound for the assessment of bone quality in preterm and term infants

Ultrasound for the assessment of bone quality in preterm and term infants

Decreased neonatal tibial bone ultrasound velocity in term infants born after breech presentation

Bone ultrasound velocity in small- versus appropriate-for-gestational age preterm infants

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