Risk factors for metabolic bone disease among preterm infants less than 32 weeks gestation with Bronchopulmonary dysplasia

Abstract

Background Bronchopulmonary dysplasia (BPD) infants present an increased incidence of metabolic bone disease (MBD), but it is unknown which factors contribute to this. The aim of this study was to determine the risk factors for developing MBD in BPD infants. Methods A retrospective review of the medical records of BPD infants admitted to the Neonatal intensive care unit at Zhangzhou Hospital between Jun 2016 and May 2020 was performed. BPD infants with MBD were identified, two contemporaneous without MBD matched by gestational age and gender were randomly selected as controls for each case of MBD. The association between putative risk factors and MBD was estimated with ORs and 95% CIs. A P-value threshold ≤0.2 was used in univariate analysis for inclusion into a multivariate (adjusted) model with a P-value of < 0.05 as statistically significant. Results A total of 156 BPD infants were enrolled with 52 cases of MBD and 104 controls. Fetal growth restriction (OR 6.00, 95% CI, 1.81–19.84), extremely low birth weight (OR 3.10, 95% CI, 1.07–8.94), feeding volume < 80 mL/kg/d at the end of the 4th week after birth (OR 14.98, 95% CI, 4.04–55.58), cholestasis (OR 4.44, 95% CI, 1.59–12.40), late onset sepsis (OR 3.95, 95% CI, 1.12–13.98) and prolonged (> 2 weeks) diuretics application (OR 5.45, 95% CI, 1.25–23.84) were found to be statistically significant risk factors for MBD in BPD infants. Conclusion In BPD infants of homogeneous gestational age, fetal growth restriction, extremely low birth weight, feeding volume < 80 mL/kg/d at the end of the 4th week after birth, cholestasis and late onset sepsis are significant risk factors for MBD. These findings provide potential predictive factors for MBD in BPD infants and warrant prospective validation.

Don’t Forget the Bones: Incidence and Risk Factors of Metabolic Bone Disease in a Cohort of Preterm Infants

“…A significant difference was also found in the incidence of bronchodysplasia and in the longer duration of mechanical and noninvasive ventilation in infants at increased risk. These data confirm the findings of the previous published studies [2,10,27,28].…”

“…The increased length of the stay in our population at risk confirms what was reported in previous study by Chen and coworkers [25,27].…”

Growth and nutrition in children with established bronchopulmonary dysplasia: A review of the literature

“…Greer et al compared 16 VLBW infants with BPD against 16 VLBW infants without BPD who were matched for GA and found no differences in energy, calcium, vitamin D, or phosphorous intake in the first 60 days of hospitalization nor any significant difference in weight, length, head circumference, or bone mineral content at 12 months of age between the two groups 14 . Among infants with BPD, Chen et al found risk factors for metabolic bone disease included prolonged (>2 weeks) use of diuretics, cholestasis, fetal growth restriction, length of stay, extremely low birth weight, and feeding volume <80 ml/kg/day at the end of the fourth week after birth 15 …”

Osteopenia of prematurity and associated nutritional factors: case–control study

“…According to the findings, this nutritional inadequacy seems to be related to the lower volume of diet offered, which also reflects a lower mineral supply and contributes to the occurrence of osteopenia. As shown by Chen et al [ 16 ], reduced enteral diet volume is a risk factor for osteopenia. The volume of human milk provided early in postnatal life is positively associated with bone mineral content [ 21 ].…”

“…The low solubility and precipitation of nutrients is a problem reported in studies that address osteopenia of prematurity, especially in the face of prolonged use of parenteral nutrition as the sole or main dietary source [ 12 ]. Therefore, along with parenteral nutrition, early enteral nutrition is recommended [ 16 ].…”