Risk factors of metabolic bone disease of prematurity

Ukarapong, Supamit; Venkatarayappa, Sunil Kumar Batlahally; Navarrete, Cristina T.; Berkovitz, Gary D.

doi:10.1016/j.earlhumdev.2017.06.010

Cited by 47 publications

(47 citation statements)

References 27 publications

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“…Postnatal immobilisation and loss of placental supply of oestrogen contribute to skeletal demineralisation 8 9. Along with gestational age, birth weight has been identified as the strongest independent risk factor for MBDP 10–12. Therefore, recommendations suggest that all infants less than 27 weeks’ gestation or with a birth weight of less than 1000 g are at high-risk of MBDP, although all infants with a birth weight less than 1500 g should be screened for MBDP 3…”

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

109

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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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

109

120

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“…This clinical entity is specified when postnatal bone mineralization is significantly lower than intrauterine bone mineralization adjusted for gestational age. The incidence for osteopenia of prematurity increases as gestational age and birth weight decrease (17) . Wei et al (1) reported that the neonates who had non-traumatic fractures had significantly lower gestational age and birth weight.…”

Section: Discussionmentioning

confidence: 99%

“…Osteopenia of prematurity usually appears between the 6 th to 12 th weeks of corrected gestational age. This clinical entity affects 20% to 30% of newborns weighing less than 1500 grams and up to 50% to 60% of newborns weighing less than 1000 grams (5,17) .…”

Section: Discussionmentioning

confidence: 99%

Long bone fractures in neonatal intensive care units of Afyonkarahisar: Five-year’s experience

Pektaş¹,

Koyuncu²,

Kundak³

2020

tjod

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Bu çalışma, Afyonkarahisar ilinde bulunan üç sağlık merkezindeki yenidoğan yoğun bakım ünitelerinde (YBÜ) tanı konulan uzun kemik kırıklarının görülme sıklığını ve bu kırıklarla ilişkili klinik özellikleri belirlemeyi amaçlamıştır. Gereç ve Yöntemler: Yenidoğan YBÜ'lerdeki klavikula kırıkları için insidans 2,4/1000 canlı doğum iken femur kırıkları için insidans 0,32/1000 canlı doğum idi. Bulgular: Doğum travmasına bağlı femur kırıkları için insidans, 1000 canlı doğumda 0,16 iken prematürite osteopenisiyle ilişkili femur kırıkları için insidans, 1000 canlı doğumda 1,08 idi. Doğum travmasına bağlı femur kırığı olguları için ortalama doğum yaşı 39 hafta, ortalama doğum ağırlığı 3308 gram ve erkek/kız oranı, 3:2 olarak bulundu. Prematürite osteopenisiyle ilişkili femur kırığı olguları için ortalama doğum yaşı 30,4 hafta, ortalama doğum ağırlığı 1256 gram ve erkek/kız oranı 2:3 olarak belirlendi. Doğum travmasına bağlı femur kırığı tanısı konulan olguların hepsi sezaryenle doğurtulmuştu ve üç olguda (%60) makat prezentasyonu bulunmaktaydı. Sonuç: Sezaryenle doğum, doğum travmasına bağlı femur kırığı riskini tamamen ortadan kaldırmadığı gibi malprezentasyon durumunda gerçekleştirilen acil sezaryen durumunda da femur kırığı riski mevcuttur. Uzun süre total parenteral nutrisyon alan ve intrauterin gelişme geriliği tanısı bulunan prematüre bebeklerde, prematürite osteopenisini önlemek için kalsiyum, fosfor ve D vitamini desteği verilmelidir.

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“…Focusing on the optimum supply of minerals and of vitamin D, by using human milk fortifier,calcium and phosphorous supplementation or preterm formula is vital to prevent MBD. Supplementing mothers with 600IU/day of vitamin D helps in preventing MBD (52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64). Conclusions Optimum nutritional supplementation of neonates with calcium, phosphorus, vitamin D along with assisted physical exercise plays a key role in preventing MBD.…”

Section: U N C O R R E C T E D P R O O Fmentioning

confidence: 99%

Metabolic Bone Disease in Premature Neonates: An Unmet Challenge

Chacham

Pasi

Chegondi

et al. 2020

Jcrpe

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The metabolic bone disease is an important morbidity in premature, very low birth weight and sick infants. If left undiagnosed, leads to structural deformities & spontaneous fractures.It is defined as impaired bone mineralization in a neonate with lower than the estimated bone mineral levels in either fetus or neonate of comparable gestational age / weight coupled with biochemical abnormalities with or without radiological manifestations. It has been reported to occur in 16% to 40% of extremely low birth weight neonates. Insufficient calcium and phosphorous stores during the phase of accelerated growth predispose to it along with use of medications (caffeine, steroids), prolonged parenteral nutrition & chronic immobilization. It presents by 6-16 weeks after birth. Enhanced physical activity in preterm infants facilitates bone mineralization and weight gain. Biochemical abnormalities tend to worsen significantly, as the severity of disease progresses. They consist of hypocalcemia, hypophosphatemia, hyperphosphatasia and secondary hyperparathyroidism. In addition, urinary phosphate wasting and hypo vitaminosis D can complicate these abnormalities. Conversely, biochemical abnormalities may not be accompanied by rachitic changes. Newer diagnostic modalities include bone densitometry by quantitative ultrasound over mid-tibial shaft (noninvasive tool). The management of metabolic bone disease includes adequate calcium, phosphorous and vitamin D supplementation along with optimum nutrition and physical activity. Similarly, preventive strategies for metabolic bone disease should target nutritional enhancement alongside enhanced physical activity. Conclusion: Metabolic bone disease is a preventable morbidity in preterm, VLBW neonates and requires optimum nutritional supplementation and enhanced physical activity.

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Risk factors of metabolic bone disease of prematurity

Cited by 47 publications

References 27 publications

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

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

Long bone fractures in neonatal intensive care units of Afyonkarahisar: Five-year’s experience

Metabolic Bone Disease in Premature Neonates: An Unmet Challenge

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