Metabolic Bone Disease in Very-Low- Birth-Weight Infants: Assessment, Prevention, and Treatment by Neonatal Nurse Practitioners

About 55% of extremely-low-birth-weight (birth weight < 1000 g) and 23% of very-low-birth-weight infants (birth weight < 1500 g) suffer from metabolic bone disease (MBD). There are limited data on the use of calcitriol (1, 25-dihydroxycholecalciferol) to prevent or treat MBD in preterm infants. Therefore, this study aimed to compare the preventive effect of calcitriol and cholecalciferol on the biochemical markers of MBD in preterm infants. This study was a pilot randomized controlled trial conducted in the Alzahra teaching hospital of Tabriz University of Medical Sciences. we randomized 72 very-low-birth-weight infants in two groups of calcitriol 0.25 µg/day and cholecalciferol 400 IU/day. Biochemical markers, including serum 25-hydroxyvitamin D, Alkaline phosphatase (ALP), Phosphorus (P), calcium (Ca), Parathyroid hormone (PTH), and tubular reabsorption of phosphate (TRP) levels were checked at baseline, three, and five weeks after medication, consecutively. After three weeks of supplementation, infants in the cholecalciferol group had higher levels of serum 25-hydroxyvitamin D (P=0.001) and lower levels of urine phosphate (P=0.009); There were no significant differences in other biochemical markers. At the end of the fifth week, there was no significant difference between the two groups in terms of biochemical markers. Conclusion: The study indicated that the use of cholecalciferol caused a lower urinary loss of phosphate in very-low-birth-weight infants at a short time; however, these findings were not sustained during the study period.

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Appropriate Phosphorus Intake by Parenteral Nutrition Prevents Metabolic Bone Disease of Prematurity in Extremely Low‐Birth‐Weight Infants

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1993 ◽

2020 ◽

Author(s):

Kouji Motokura ◽

Seiichi Tomotaki ◽

Shintaro Hanaoka ◽

Takeru Yamauchi ◽

Hiroko Tomotaki ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Parenteral Nutrition ◽

Bone Disease ◽

Metabolic Bone Disease ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Metabolic Bone ◽

Phosphorus Intake

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Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life

Pediatric Radiology ◽

10.1007/s00247-020-04817-8 ◽

2020 ◽

Author(s):

Liting Tong ◽

Sarita Pooranawattanakul ◽

Jaya Sujatha Gopal-Kothandapani ◽

Amaka C. Offiah

Keyword(s):

Emergency Department ◽

Birth Weight ◽

Linear Regression ◽

Low Birth Weight ◽

Preterm Infants ◽

Bone Disease ◽

Metabolic Bone Disease ◽

Categorical Variables ◽

Metabolic Bone ◽

Significant Difference

Abstract Background Preterm infants may be more vulnerable to fractures due to various factors, including metabolic bone disease, but an increased risk of fractures up to the age of 2 is unproven. Objective To compare fracture patterns in premature and full-term children in the first 3 years of life. Materials and methods A retrospective study was conducted. We excluded any child who returned with the same injury, with known metabolic bone disease, with any disease or condition known to reduce bone density, who received any medication known to affect Vitamin D metabolism within 3 months of enrollment or who had fractures post-surgery/resuscitation. Variables such as the number of fractures sustained each year, age of presentation to the Emergency Department and mechanism of injury were compared between the preterm and term groups using statistical analysis (χ2 and Fisher exact test for categorical variables and Student’s t-test for continuous variables). Simple linear regression was performed on the total number of fractures sustained by age 3. Results Forty-four children with fractures were included. Of these, none were born extremely preterm, 24 (55%) were preterm, and 20 (45%) were born at term. Mean gestational ages of the preterm and term groups were 32 weeks 3 days and 39 weeks 6 days, respectively. There were no extremely low birth weight or very low birth weight children. There was no significant difference in the number of fractures sustained yearly, the age of presentation to the Emergency Department or the site of fracture between preterm and term groups. Linear regression showed that the total number of fractures sustained by age 3 years was unrelated to prematurity status, gender or birth weight category. Conclusion No significant difference in fracture number or pattern was identified.

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