How to use… alkaline phosphatase in neonatology

Background: Metabolic bone disease (MBD) of prematurity is a complication of multifactorial aetiology, which has been increasing, due to progressive decrease in mortality of preterm newborns. The aim of the study was to analyze risk factors of severe MBD and its analytical markers. Patients and Method: Retrospective study involving preterm infants less than 32 weeks gestational age and/or weight less tan 1,500 g born between january 2012 and december 2014. Comparison was made according to the presence of severe MBD. Results: 139 patients were recruited. Mean value of 25(OH)D3 was 70.68 ± 25.20 nmol/L, being higher in patients born in spring-summer than in autumn-winter (80.94 ± 25.33 vs 61.13 ± 21.07; p = 0.000). Levels of 25(OH)D3 were similar in patients with severe MBD compared with the rest of patients (65.61 ± 26.49 vs 72.07 ± 24.89, P = 0.283). Higher levels of alkaline phosphatase (AP, IU/L ) (1314.19 ± 506.67 vs 476.56 ± 188.85; p = 0.000) were found in these patients. Cutoff point of AP 796.5 IU/L (S 95.2%, specificity 92.4%) was calculated by ROC curve. The risk factors most associated to severe EMO were restricted fetal growth, birth weight, duration of ventilation therapy and parenteral nutrition. Conclusions: AP levels were the best marker of severe MBD development. EMO risk increases with the number of risk factors and lower levels of 25(OH) D3. Levels of 25(OH)D3 higher than 70nmol/L appear to protect from the development of severe MBD, even in patients with multiple risk factors.

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“…This is in contrast to other studies, in which it is considered as lower values around 500 IU/L 1,12,13,23 .…”

Section: Discussioncontrasting

confidence: 49%

Factores de riesgo y marcadores bioquímicos de la enfermedad metabólica ósea del recién nacido prematuro

Ramón

Espuelas

Calmarza

et al. 2017

Rev. chil. pediatr.

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“…The role of ALP in bone mineralization is controversial, but an increase is usually associated with poor bone mineralization [30,51]. According to our results, an increasing intake of protein was associated with an increase in ALP.…”

Section: Discussionsupporting

confidence: 58%

“…However, there is currently neither a consensus on the appropriateness of either parameter or the frequency of measurements [29,30]. A recent survey among U.S. neonatologists showed a great lack of consensus and variation in practices regarding definition and screening methods for metabolic bone disease [31].…”

Section: Introductionmentioning

confidence: 99%

Changes in Biochemical Parameters of the Calcium-Phosphorus Homeostasis in Relation to Nutritional Intake in Very-Low-Birth-Weight Infants

et al. 2016

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Preterm infants are at significant risk to develop reduced bone mineralization based on inadequate supply of calcium and phosphorus (Ca-P). Biochemical parameters can be used to evaluate the nutritional intake. The direct effect of nutritional intake on changes in biochemical parameters has not been studied. Our objective was to evaluate the effect of Ca-P supplementation on biochemical markers as serum (s)/urinary (u) Ca and P; alkaline phosphatase (ALP); tubular reabsorption of P (TrP); and urinary ratios for Ca/creatinin (creat) and P/creatinin in Very-Low-Birth-Weight infants on Postnatal Days 1, 3, 5, 7, 10, and 14. This observational study compared two groups with High (n = 30) and Low (n = 40) intake of Ca-P. Birth weight: median (IRQ) 948 (772–1225) vs. 939 (776–1163) grams; and gestational age: 28.2 (26.5–29.6) vs. 27.8 (26.1–29.4) weeks. Daily median concentrations of biochemical parameter were not different between the groups but linear regression mixed model analyses showed that Ca intake increased the uCa and TrP (p = 0.04) and decreased ALP (p = 0.00). Phosphorus intake increased sP, uP and uP/creat ratio and ALP (p ≤ 0.02) and caused decrease in TrP (p = 0.00). Protein intake decreased sP (p = 0.000), while low gestational age and male gender increased renal excretion of P (p < 0.03). Standardized repeated measurements showed that biochemical parameters were affected by nutritional intake, gestational age and gender.

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“…Newborns receiving sufficient nutrition may have only smaller rises in alkaline phosphatase. 18 This is the explanation behind the reason of taking biochemical sample at 3 weeks of age by most of the author. In this study, biochemical markers at 3 weeks of age were used to determine predictability of osteopenia at corrected term age.…”

Section: Discussionmentioning

confidence: 99%

Biochemical Bone Markers for Early Detection of Osteopaenia of Prematurity

Jahan¹,

Mannan²,

Dey³

et al. 2017

Bangladesh Med Res Counc Bull

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Osteopenia of prematurity (OOP) imposes the risk of fractures and growth failure to premature infants. Studies have investigated the validity of biochemical markers of osteopenia but till date it is not established. So, this study was intended to examine the diagnostic performance of biochemical markers in early detection of osteopenia of prematurity. This prospective study was conducted in the Neonatal Intensive Care Unit (NICU), Department of Neonatology, Bangabandhu Sheikh Mujib Medical University during June 2013 to February 2014. A total of 100 premature infants with gestational age ≤ 34 weeks were consecutively included over 9 months period. Serum alkaline phosphatase, serum calcium and serum inorganic phosphates were measured from 1 week of chronological age until corrected term age. At corrected term age, radiologic examination was done for the assessment of osteopenia. Of the enrolled infants, 36/78 (46%) developed radiological evidence of osteopenia. Serum inorganic phosphate level was significantly less in osteopenic infants than non-osteopenic infants throughout first two months of life (p <0.001). The area under ROC curve for serum inorganic phosphate was 85% (p = 0.001). If the cut off value of serum inorganic phosphate was set at 3.6 mg/dl, then a sensitivity of 86% and a specificity of 49% were obtained. Low serum inorganic phosphate at 3 weeks of life can be used as a marker for early detection of osteopenia of prematurity.

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How to use… alkaline phosphatase in neonatology

Cited by 64 publications

References 33 publications

Factores de riesgo y marcadores bioquímicos de la enfermedad metabólica ósea del recién nacido prematuro

Factores de riesgo y marcadores bioquímicos de la enfermedad metabólica ósea del recién nacido prematuro

Changes in Biochemical Parameters of the Calcium-Phosphorus Homeostasis in Relation to Nutritional Intake in Very-Low-Birth-Weight Infants

Biochemical Bone Markers for Early Detection of Osteopaenia of Prematurity

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