Evaluation of radiologic evidence of metabolic bone disease in very low birth weight infants at fourth week of life

Abstract

Aim The aim of this study is to determine the incidence of metabolic bone disease (MBD) and assess the risk factors for development radiologic evidence of MBD. Methods Preterm infants with gestational age ≤32 weeks and birth weight ≤1500 g were included in this prospective study. Metabolic bone disease was defined as hypophosphatemia (phosphorus levels <4 mg/dl), ALP levels >450 U/L, or radiologic findings of MBD at four weeks of age. Results The study included 254 infants (gestational age: 29 (27–30) weeks, birth weight: 1130 g (960–1300)). Metabolic bone disease was diagnosed in 96 patients (37%); 48 infants had only radiologic evidence of MBD, 24 infants had only biochemical diagnosis of MBD, and 24 infants had both radiologic evidence of MBD and biochemical diagnosis of MBD. Conclusions Our results showed that radiologic evidence of MBD existed in some infants with normal biochemical results. That finding may guide further development of screening programs for MBD.

Don’t Forget the Bones: Incidence and Risk Factors of Metabolic Bone Disease in a Cohort of Preterm Infants

“…A total of 289 VLBWIs were enrolled in the present study; 51 infants died during the first six weeks of life (mean days of life at death was 10.27 ± 7.5 days, range 1-31), so 238 subject with a mean gestational age of 29.2 ± 1.98 weeks and mean birth weight of 1131.13 ± 258.20 g were included in the final analysis (male 45%, twins 51%). According to serum P and ALP concentration performed at 25.84 ± 3.45 days of life [19][20][21][22][23][24][25][26], subjects were divided into two groups: G1 (=52 subjects) infants were at increased risk of MBD as they had P ≤ 4.5 mg/dl or ALP ≥ 900 UI/L, while G2 (=186 subjects) infants did not have an increased risk of MBD. Table 1 reports clinical data in G1 and G2.…”

“…Nevertheless, as pointed out by Kavurt and colleagues, it is difficult to understand if metabolic bone disease is a cause or consequence of pulmonary bronchodysplasia. Indeed, if the chronic use of some medications and prolonged immobility due to mechanical ventilation could be the first step of alteration in the deposition of mineral content in bones, on the other hand the alteration in bone mineralization and structure could itself influence chest wall compliance and make it difficult to wean the patients from ventilator support [19].…”

“…Despite advances in neonatal intensive care and implementation of nutritional support, MBD is still frequent in preterm infants, with an incidence of 16-23% in very-low-birth-weight (VLBW, birth weight <1500 g) infants and in 40-60% in extremely low-birth-weight (ELBW, birth weight <1000 g) infants [11,17]. Moreover, MBD occurrence is inversely related to gestational age and birth weight [3,18], with a peak of incidence at 3-5 weeks of life [19].…”

“…Moreover, even if in the majority of cases MBD is a self-limiting condition, in some cases it could lead to a permanent alteration of bone structure that could cause growth faltering and alteration of respiratory patterns due to excessive chest wall compliance [19].…”

Artificial Neural Network Modeling to Predict Neonatal Metabolic Bone Disease in the Prenatal and Postnatal Periods

“… 16 Furthermore, contemporary research often investigates preterm infants, using relatively small sample sizes, 17 with few having studied MBD among infants in general. 18 , 19 …”