The Clinical and Biochemical Predictors of Bone Mass in Preterm Infants

Czech‐Kowalska, Justyna; Czekuc-Kryskiewicz, Edyta; Płudowski, Paweł; Zaniuk, Katarzyna; Jaworski, Maciej; Łuba, Anna; Grzybowska, Karolina; Piłat, Krystyna; Dobrzańska, Anna

doi:10.1371/journal.pone.0165727

Cited by 19 publications

(28 citation statements)

References 50 publications

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“…Czech‐Kowalska et al . reported that PTH was the only independent predictor of low bone mass in ex‐preterm infants who had DEXA at 40 weeks corrected gestational age …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Do preterm bones still break? Incidence of rib fracture and osteopenia of prematurity in very low birth weight infants

O’Reilly

Saviani

Tou

et al. 2020

J Paediatrics Child Health

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Aim Extremely premature babies are at risk of osteopenia of prematurity (OOP) as bone mineralisation in utero increases exponentially after 24 weeks gestation. Our aim was to assess the bone health of very low birth weight (VLBW) infants. We wanted to establish the incidences of OOP and rib fracture. We also looked at which biochemical markers best predicted OOP. Bone health in this vulnerable population is an important aspect of management which should not be overlooked. Methods This was an observational study which included all VLBW infants, born in a national maternity hospital, over a 5‐year period. All X‐rays performed on these infants were reviewed. Data were also collected on biochemical markers associated with bone health. The medical records of infants with rib fractures were reviewed looking for causes of bone fragility. Results Of the 609 VLBW infants included in the study, only two cases of definitive rib fractures were found. This represents a rib fracture incidence of 3 per 1000. Thirty‐nine percent of VLBW babies showed radiological evidence suggestive of OOP. Conclusion Our findings show a lower rate of rib fracture in preterm infants compared to previous evidence. We also showed that these fractures were not evident on the final X‐ray prior to discharge. This implies that when an ex‐preterm infant presents to the emergency department with a rib fracture there should be an even higher suspicion for non‐accidental injury than previously thought.

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“…Czech‐Kowalska et al . reported that PTH was the only independent predictor of low bone mass in ex‐preterm infants who had DEXA at 40 weeks corrected gestational age …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Do preterm bones still break? Incidence of rib fracture and osteopenia of prematurity in very low birth weight infants

O’Reilly

Saviani

Tou

et al. 2020

J Paediatrics Child Health

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“…However, despite its specificity, there is no a clear relationship between serum OC levels and bone mineral content in the first 4 months of life (33). It has been demonstrated that serum PTH levels might predict a reduction of bone mineral content in preterm infants who have reached the at term age, while urinary phosphate excretion and OC might be useful markers to predict a low bone mineralization at 3 months of corrected age (34).…”

Section: Introductionmentioning

confidence: 99%

Metabolic Bone Disease of Prematurity: Diagnosis and Management

Faienza

D’Amato

Natale³

et al. 2019

Front. Pediatr.

110

138

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Metabolic Bone Disease (MBD) of prematurity is a multifactorial disorder commonly observed in very low birth weight (VLBW, <1,500 g) newborns, with a greater incidence in those extremely low birth weight (ELBW, <1,000 g). MBD is characterized by biochemical and radiological findings related to bone demineralization. Several antenatal and postnatal risk factors have been associated to MBD of prematurity, although the main pathogenetic mechanism is represented by the reduced placental transfer of calcium and phosphate related to preterm birth. The diagnosis of MBD of prematurity requires the assessment of several biochemical markers, radiological, and ultrasonographic findings. However, the best approach is the prevention of the symptomatic disease, based on the screening of subjects exposed to the risks of developing MBD. Regarding the subjects who need to be screened, there is a substantial agreement on the potential risk factors for MBD. On the contrary, different recommendations exist on the diagnosis, management and treatment of this disorder of bone metabolism. This review was aimed at: (1) identifying the subjects at risk for MBD of prematurity; (2) indicating the biochemical findings to take in consideration for the prevention of MBD of prematurity; (3) suggesting practical recommendations on nutritional intake and supplementation in these subjects. We searched for papers which report the current recommendations for biochemical assessment of MBD of prematurity and for its prevention and treatment. The majority of the authors suggest that MBD of prematurity is a disease which tends to normalize overtime, thus it is not mandatory to mimic the rate of mineral fetal accretion through parenteral or enteral supplementation. The optimization of total parenteral nutrition (TPN) and the early achievement of a full enteral feeding are important goals for the prevention and management of MBD of prematurity.

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“…When combined with low serum phosphate, an elevated PTH was 100% sensitive and 94% specific in identifying MBDP. In 160 preterm infants, Czech-Kowalska et al 56 found only PTH to be a predictor of low bone mineral content at term age using DXA scan. Considering the pathophysiology, one would expect that plasma PTH would become elevated earlier than changes in ALP or phosphate.…”

Section: Introductionmentioning

confidence: 99%

Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences

Chinoy

Mughal²,

Padidela³

2019

Arch Dis Child Fetal Neonatal Ed

104

120

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Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP – primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.

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The Clinical and Biochemical Predictors of Bone Mass in Preterm Infants

Cited by 19 publications

References 50 publications

Do preterm bones still break? Incidence of rib fracture and osteopenia of prematurity in very low birth weight infants

Do preterm bones still break? Incidence of rib fracture and osteopenia of prematurity in very low birth weight infants

Metabolic Bone Disease of Prematurity: Diagnosis and Management

Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences

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