AO-45. Incidence of osteopenia of prematurity in preterm infants who were exclusively fed breast milk

Bandara, Sandya; Kariyawasam, Amila

doi:10.1016/j.earlhumdev.2010.09.053

Cited by 7 publications

(6 citation statements)

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“…It has been demonstrated that newborns fed exclusively with breast milk showed lower levels of phosphate than those receiving special formulas or mineral supplementation (16). In addition, preterm infants fed with unfortified human milk present rickets in 40% of the cases, compared to the 16% of those fed with special formulas (17).…”

Section: Introductionmentioning

confidence: 99%

Metabolic Bone Disease of Prematurity: Diagnosis and Management

Faienza

D’Amato

Natale³

et al. 2019

Front. Pediatr.

114

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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Section: Introductionmentioning

confidence: 99%

Metabolic Bone Disease of Prematurity: Diagnosis and Management

Faienza

D’Amato

Natale³

et al. 2019

Front. Pediatr.

114

138

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“…VLBW, delayed establishment of full enteral feedings and long term use of parenteral nutrition are risk factors for OOP. In exclusively breast fed infants OOP does not depend on the severity of the prematurity 10 . Common neonatal conditions such as sepsis, cerebral pathology, muscular disorders and paralysis may result in prolonged periods of immobility, well recognized as a risk factor for poor bone mineralization.…”

Section: Risk Factorsmentioning

confidence: 87%

Osteopenia of prematurity: Are we on the right track?

Bandara¹,

Kariyawasam²

2012

Sri Lanka J Child Health

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“…Early MBD is associated with male sex, increased initial ALP levels, and breastfeeding. Human milk alone may have inadequate protein and mineral content to promote optimal growth in the preterm infant because phosphate levels are lower in premature babies and breastfed infants (19)(20)(21). A lower phosphate level accompanied by initial high ALP levels and the effect of accumulation over time would affect bone mineralization, leading to the early occurrence of MBD.…”

Section: Discussionmentioning

confidence: 99%

Screening of Serum Alkaline Phosphatase and Phosphate Helps Early Detection of Metabolic Bone Disease in Extremely Low Birth Weight Infants

et al. 2021

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Background: Extremely low birth weight (ELBW, <1,000 g) infants have a high risk of metabolic bone disease (MBD). Because of the late appearance of radiological signs, diagnosis of MBD in ELBW infants might be delayed, and its prevalence underestimated in this group of patients. This study adopted serial screening of serum alkaline phosphatase (ALP) and phosphate (P) of ELBW infants to determine whether such screening is helpful for the early detection of MBD.Materials and Methods: We performed a retrospective study of preterm infants with a gestational age ≤ 31 weeks and birth weight <1,000 g. MBD was absent (ALP ≤500 IU/L), mild (ALP >500 IU/L, P ≥4.5 mg/dL), and severe (ALP >500 IU/L, P <4.5 mg/dL); MBD was divided into early MBD (≤4 weeks after birth) and late MBD (>4 weeks after birth) according to the time of onset.Results: A total of 142 ELBW infants were included, with a median gestational age of 28.1 (26.5–29.7) weeks and a median birth weight of 875 (818–950) g. Seventy-three cases of MBD were diagnosed, and the total prevalence was 51.4% (mild MBD, 10.6%; and severe MBD, 40.8%). Male sex, breastfeeding, and sepsis would increase the risk of severe MBD. Most MBD in ELBW infants occurred at 3–4 weeks after birth. Sixty-two percent (45/73) of infants were diagnosed as having early MBD, which are diagnosed earlier than late MBD [24 (21–26) vs. 39 (36–41), t = −7.161; P < 0.001]. Male sex [odds ratio (OR), 2.86; 95% confidence interval (CI), 1.07–7.64; P = 0.036], initial high ALP levels (OR, 1.02; 95% CI, 1.01–1.03; P < 0.001), and breastfeeding (OR, 5.97; 95% CI, 1.01–25.12; P = 0.049) are independent risk factors for the development of early MBD.Conclusion: The risk of MBD among ELBW infants is very high. Most cases occurred early and were severe. Male sex, initial high ALP levels, and breastfeeding are closely related to the increased risk of early MBD. Serial screening of serum ALP and P helps early detection of MBD; it is recommended to start biochemical screening for ELBW infants 2 weeks after birth and monitor their biochemical markers weekly.

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AO-45. Incidence of osteopenia of prematurity in preterm infants who were exclusively fed breast milk

Cited by 7 publications

References 0 publications

Metabolic Bone Disease of Prematurity: Diagnosis and Management

Metabolic Bone Disease of Prematurity: Diagnosis and Management

Osteopenia of prematurity: Are we on the right track?

Screening of Serum Alkaline Phosphatase and Phosphate Helps Early Detection of Metabolic Bone Disease in Extremely Low Birth Weight Infants

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