Serial measurements of serum alkaline phosphatase for early prediction of osteopaenia in preterm infants

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%

“…Any parameter can be considered isolated as MBD marker, although the most commonly used is the serum alkaline phosphatase. The figures that determine the diagnosis are not clearly defined in the literature, but in some series it is accepted that above 500 IU/L as a high sensitivity and specificity, and in others, above 700 IU/L 1,12,13 .…”

Section: Introductionmentioning

confidence: 99%

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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“…In this study, infants receiving early fortification had a significantly lower incidence of having an alkaline phosphatase level >500 starting at 33 weeks PMA. Elevated alkaline phosphatase levels and low serum phosphorus levels have been shown to be an early predictor of metabolic bone disease in premature infants 23,24 as well as a good predictor of length at 18 months and height at adolescence. 25,26 More recent data suggest that calcium and phosphorus supplementation does not need to necessarily match the high intrauterine accretion rates, suggesting that adaptation and stimulation, by the preterm infant itself, may provide part of the mineral requirements for postnatal bone formation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of human milk fortification from the time of the first feeding: effects on infants of less than 31 weeks gestational age

2011

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Objective: To determine whether human milk fortification from the time of the first feeding significantly improves weight gain and bone mineral status in infants of <31 weeks estimated gestational age as compared with delayed or standard human milk fortification.Study Design: This was a retrospective pre-post design. In all, 95 infants born at <31 weeks estimated gestational age were compared. There were 53 infants in the early fortification group (EFG) and 42 infants in the delayed fortification group (DFG). They were compared with regard to weight gain at 34 weeks postmenstrual age (PMA), and their serum levels of calcium, phosphorus and alkaline phosphatase levels were compared as an indicator of bone mineral status. The practice change of fortifying all human milk given to preterm infants at <34 weeks PMA commenced in June 2009. The usual practice of fortification took place once an infant had reached a feeding volume of 50 to 100 ml kg À1 per day. The new practice fortified all human milk with a powdered human milk fortifier to 24 calories per ounce, starting with the first feeding, no matter how small the volume.Result: There were no differences in weight gain between the EFG and the DFG. The group that received fortification from the time of the first feeding were significantly less likely to have alkaline phosphatase levels >500 U l À1 from 33 weeks PMA onward. There was no incidence of feeding intolerance with early fortification.Conclusion: Fortification of human milk from the time of the first feeding does not affect weight gain at 34 weeks PMA, but is related to a lower incidence of elevated alkaline phosphate levels and does not cause feeding intolerance.

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“…However, the radiological changes of osteopenia are not easily detected until bone mineralization is reduced by at least 20%. 12 Dual energy X-ray absorptiometry (DEXA) is considered to reflect most accurately the state of bone mineralization. Because of the rarity of DEXA instruments, a biochemical marker would be a good alternative in resource limited centers.…”

Section: Introductionmentioning

confidence: 99%

“…Most of the authors suggested 3 weeks of life as early period of screening as alkaline phosphatase level rises in all newborns in the first 2-3 weeks of life and increases further if there is insufficient mineral supply. 12 Hung et al concluded that serum ALP exceeding 700IU/L at 3 weeks post natal age can predict the risk of osteopenia of prematurity. 12 Backstrom et al showed that high serum alkaline phosphatase activity and low serum phosphate level are the best available screening method for low bone mineral density.…”

Section: Introductionmentioning

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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Serial measurements of serum alkaline phosphatase for early prediction of osteopaenia in preterm infants

Abstract: Serum ALP concentration exceeding 700 IU/L at 3 weeks post-natal age can predict the risk of osteopaenia in preterm infants.

Cited by 71 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

Evaluation of human milk fortification from the time of the first feeding: effects on infants of less than 31 weeks gestational age

Biochemical Bone Markers for Early Detection of Osteopaenia of Prematurity

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