Plasma alkaline phosphatase activity in rickets of prematurity.

Glass, E J; Hume, Robert; Hendry, G. M. A.; Strange, R. C.; Forfar, J. O.

doi:10.1136/adc.57.5.373

Cited by 50 publications

(25 citation statements)

References 14 publications

(1 reference statement)

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“…Some infants reach ALP levels 5–10 times the upper limit of the adult normal range. This may take 2–3 months to peak14 and is often associated with prolonged parenteral nutrition.…”

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

“…Plain film appearances diagnostic of MBD have a lag time of 2–6 weeks from occurrence of peak ALP levels,14 which renders both a threshold level of ALP and serial use of plain films unhelpful in prospectively identifying MBD. In one series21 only a single infant who previously passed the ‘high’ ALP cut-off had radiological evidence of bone disease with formal scoring of the films.…”

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

“…There is no evidence to support any specific ALP level as a threshold for stopping treatment primarily because of the lack of reliable temporal associations between ALP peak/trough level and MBD measured directly or by imaging 14 16. If treatment is started with supplemental phosphate or calcium, repeat measures along with linear growth assessment may help determine efficacy, progress and when to stop, but quantitative measurement of bone mineralisation is rarely possible in routine practice 25…”

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

“…Preterm infants have higher ALP levels14 and lower BMC at term corrected age than term-born infants 14 22. Only Faerk et al 16 specifically looked at BMC in ex-preterm infants at term corrected gestational age.…”

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

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How to use… alkaline phosphatase in neonatology

Tinnion¹,

Embleton

2012

Arch Dis Child Educ Pract Ed

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Alkaline phosphatase (ALP) is regularly measured in clinical practice. Changes in serum levels are observed in a number of clinical conditions. In neonatology, it has been proposed as a useful marker for both a diagnosis and an indication of the severity of metabolic bone disease (MBD) in infants born preterm. Nutritional practices, aimed at reducing the occurrence or severity of MBD, have led to ALP being proposed as a stand-alone means of monitoring treatment. The current evidence does not support this use: ALP only achieves usefulness in a diagnostic and monitoring capacity when combined with other serum and imaging techniques.

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“…Some infants reach ALP levels 5–10 times the upper limit of the adult normal range. This may take 2–3 months to peak14 and is often associated with prolonged parenteral nutrition.…”

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

Section: Metabolic Bone Disease Of Prematuritymentioning

confidence: 99%

See 2 more Smart Citations

How to use… alkaline phosphatase in neonatology

Tinnion¹,

Embleton

2012

Arch Dis Child Educ Pract Ed

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“…Backstrom et al (25) reported that a serum ALP value above 900 U/L was related with low bone mineral density, its sensitivity was 88% and specificity was 71% and a serum P level of <5,5 mg/dL was related with low bone mineral density and its sensitivity was 96% and specificity was 50%. Glass et al (26) reported that an ALP value of >900 IU/l had a sensitivity of 100% in the diagnosis of osteopenia and combination of an ALP value of >800 IU/dL and a P value of <3.5 mg/dL defined severe osteopenia. In our study, we used decreased P and increased ALP in combination in defining osteopenia.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the place of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity

et al. 2015

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Aim: In this study, we aimed to investigate the utility of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity in addition to biochemical markers. Material and Methods: Premature babies with a gestational age of ≤32 weeks and/or a birth weight of ≤1 500 g who were hospitalized in the neonatal intensive care unit between June 2009 and March 2011 were included in the study. These babies were evaluated at the 40th gestational week and serum calcium, phosphorus, alkaline phosphatase, urea, creatinine, urinary calcium and phosphorus levels were measured and tubular reabsorption of phosphorus was determined. The subjects who had bone graphy findings and/or an alkaline phosphatase level of >400IU/L and a phosphorus value of <3.5 mg/dL were considered osteopenic. The levels of tubular reabsorption of phosphorus of the osteopenic patients were compared with the ones of the non-osteopenic patients. The study was initiated after obtaining ethics committee approval (date: 04.29.2009/213). Results: During the study period, a total of 698 premature babies were hospitalized in our neonatology unit. A diagnosis of osteopenia of prematurity was made in 24 of 190 subjects who met the study criteria. The level of tubular reabsorption of phosphorus was compared with the serum calcium, phosphorus and alkaline phosphatase levels measured at the 40th gestational week and alkaline phosphatase was found to be significantly increased in the group with a high tubular reabsorption of phosphorus (≥%95). When the subjects with a phosphorus level of <3.5 mg/dL and an alkaline phosphatase level of >499 IU were compared with the newborns who were found to have a tubular reabsorption of phosphorus of ≥%95 for the objective of evaluating the specificity and sensitivity of tubular reabsorption of phosphorus, the sensitivity, specificity, positive predictive value and negative predictive value of tubular reabsorption of phosphorus in the diagnosis of osteopenia were found to be 27%, 82%, 17% and 89%, respectively. When the osteopenic and non-osteopenic patients were compared in terms of the levels of tubular reabsorption of phosphorus, no statistically significant difference was found. Conclusions: It was thought that it was not appropriate to use tubular reabsorption of phosphorus alone in the diagnosis of osteopenia of prematurity. (Türk Ped Arş 2015; 50: 45-50)

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