The incidence of osteopenia of prematurity in preterm infants without phosphate supplementation

Abstract

To meet their requirements for bone mineralization, it is recommended that preterm infants receive nutritional support containing calcium and phosphate. There are no clear data on the incidence of osteopenia of prematurity (OFP) in preterm infants without phosphate supplementation. This study aimed to investigate the incidence of OFP in preterm infants without phosphate supplementation and its relationship with the duration of parenteral nutrition (PN). This was a prospective and observational study. This study included 30 infants aged <32 gestational weeks and weighed <1500 g at birth. All infants received PN according to a standard protocol, beginning on day 1 with calcium, without phosphate. Starting from the first day of life, all infants received human milk without fortifiers. Oral vitamin D (400 IU/d) was administered when enteral nutrition reached 100 mL/kg/d. The diagnosis of OFP was based on radiographs that were taken of both wrists. Serum alkaline phosphatase (ALP) was measured 3 times: at the start of PN (ALP 1), at the end of PN (ALP 2), and at discharge or the expected due date (ALP 3). Radiographs were obtained on the same day as ALP 3. The duration of PN was analyzed in the presence of OFP using receiver operating characteristic curve analysis. Among the 30 infants, 13 (43%) were diagnosed with OFP. The duration of PN was significantly longer in the OFP group than in the group without OFP (16 vs 12 days; P < .05). The provision of PN for >15 days significantly increased the risk of OFP (odds ratio, 5.40; 95% confidence interval, 1.12–26.04; P = .035). We found a high incidence of OFP in preterm infants without phosphate supplementation. An association was found between the duration of PN and the incidence of OFP. Further research is needed to prevent the development of osteopenia in preterm infants.

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

“…The rate of MBD found in our population reflects what is reported in the literature, i.e., 22% VLBWI with gestational age < 32 weeks are at an increased risk of developing MBD during hospital stays [10,[20][21][22][23]. This is probably a consequence of the fact that the highest bone mineralization occurs in the last trimester of pregnancy, and that intrauterine growth retardation may be associated with placental dysfunction, and therefore a reduction in nutrient supply from mother to fetus [2,25].…”

“…A total of 289 VLBWIs were enrolled in the present study; 51 infants died during the first six weeks of life (mean days of life at death was 10.27 ± 7.5 days, range 1-31), so 238 subject with a mean gestational age of 29.2 ± 1.98 weeks and mean birth weight of 1131.13 ± 258.20 g were included in the final analysis (male 45%, twins 51%). According to serum P and ALP concentration performed at 25.84 ± 3.45 days of life [19][20][21][22][23][24][25][26], subjects were divided into two groups: G1 (=52 subjects) infants were at increased risk of MBD as they had P ≤ 4.5 mg/dl or ALP ≥ 900 UI/L, while G2 (=186 subjects) infants did not have an increased risk of MBD. Table 1 reports clinical data in G1 and G2.…”

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

“…The study showed an incidence of 40% of the disease, which is within the range reported in the literature. Although it is suggested that early diagnosis based on biochemical tests may overestimate cases of osteopenia, our result corroborates a recent study by Angelika et al [ 39 ], which found 43% of newborns with the disease, diagnosed by imaging tests, highlighting its importance as an incident comorbidity in preterm newborns, regardless of the screening method.…”

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

“…The incidence of MBDP is inversely related to the birth weight and gestational age. Previous studies have identified the incidence as high as 10% of low-birth-weight babies (LBW) less than 2500 g, 20% of very-low-birthweight (VLBW) babies -less than 1500 g and 30-60% of extreme low-birth-weight (ELBW) babies less than 1000 g 2,6]. Despite guidelines from the American Academy of Pediatrics Committee on Nutrition since 2013 [3], there continues to exist a wide variety of approaches to screening and managing MBDP across NICU centers [7].…”