Catch it before it breaks!: managing metabolic bone disease of prematurity

Abstract

Purpose of review Metabolic bone disease of prematurity, commonly referred to as osteopenia of prematurity, remains prevalent in the neonatal intensive care unit (NICU) despite recent medical advances. It is estimated that up to 60% of extreme low birth weight and 20% of very low-birth-weight infants have metabolic bone disease of prematurity. Often silent, it typically presents with poor growth, increased ventilator dependency and fractures. Clinical sequalae, such as short stature can extend into young adulthood. There is no universal consensus by neonatal intensive care unit clinicians on the screening, diagnosis, or treatment for metabolic bone disease of prematurity. The disease is often diagnosed late by radiographs or incidentally in this highly fragile population. Recent findings Suggest screening using DEXA (dual-energy X-ray absorptiometry) scans or ultrasound, in combination with serum markers like alkaline phosphatase, phosphorous levels, parathyroid hormone, and tubular reabsorption of phosphate, might identify at-risk babies earlier. The use of protocol-based screenings may aid in early diagnosis. Summary We present a review of the risk factors, recent screening methods, diagnosis and management of this prevalent, clinically relevant diagnosis, as well as propose a protocol for the early screening and management of this silent disease.

Use of dietary supplements by children and adolescents

“…In preterm newborns, breast milk is insufficient to provide the necessary amount of calcium and phosphorus. 44 On average, breast milk contains 30 mg of calcium, 15 mg of phosphorus, and 8 IU of vitamin D per 100 mL, while the needs of newborns on full enteral feeding are 140 to 160 mg/Kcal/day of calcium and 95 to 108 mg/Kcal/day of phosphorus (alkaline phosphatase- AP). Formulas for preterm infants contain, on average, 90 to 150 mg of calcium and 50 to 90 mg of phosphorus for every 100 mL.…”

Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

“…124 Table 5 provides a brief description of each phase with specific expert recommendations. 124 Ongoing monitoring of anthropometric data should occur throughout both inpatient and outpatient phases of care along with screening for metabolic bone disease 297 and anemia of prematurity. Electrolyte abnormalities are common in patients receiving diuretic therapy and should be identified and treated accordingly.…”