Metabolic Bone Disease of Prematurity: Risk Factors and Associated Short-Term Outcomes

Despite the importance of early recognition of metabolic bone disease (MBD) of prematurity, there is still significant variability in screening practices across institutions. We conducted an observational study of infants born at ≤32 weeks of gestation with a birth weight of ≤1500 g (n = 218) to identify clinical factors associated with biochemical indicators of MBD. Bone mineral status was assessed by measuring alkaline phosphatase and phosphate levels between weeks 3 and 5 of life. Two comparisons were performed after classifying infants as either MBD (cases) or non-MBD (controls), and as either high or low risk for MBD, as determined based on the results of MBD screening. In total, 27 infants (12.3%) were classified as cases and 96 (44%) as high-risk. Compared with controls, MBD infants had a significantly lower gestational age and birth weight, and a longer duration of parenteral nutrition and hospital stay. Respiratory outcomes were significantly poorer in high- versus low-risk infants. Multivariate logistic regression showed that birth weight was the only independent risk factor for MBD (odds ratio [OR]/100 g, 0.811; confidence interval [CI95%], 0.656–0.992; p = 0.045) and that birth weight (OR/100 g, 0.853; CI95%, 0.731–0.991; p = 0.039) and red blood cell transfusion (OR, 2.661; CI95%, 1.308–5.467; p = 0.007) were independent risk factors for high risk of MBD. Our findings provide evidence of risk factors for MBD that could help clinicians to individualize perinatal management. The association of red blood cell transfusion with MBD is a novel finding that may be related to iron overload and that merits further study.

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

BMC Pediatrics ◽

10.1186/s12887-021-02705-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenwen Chen ◽

Zhenhai Zhang ◽

Shuzhen Dai ◽

Liping Xu

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Gestational Age ◽

Bone Disease ◽

Metabolic Bone Disease ◽

Late Onset ◽

Significant Risk ◽

Extremely Low Birth Weight ◽

Metabolic Bone ◽

Late Onset Sepsis

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.

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Postnatal Changes in Humerus Cortical Bone Thickness Reflect the Development of Metabolic Bone Disease in Preterm Infants

Disease Markers ◽

10.1155/2016/2176594 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Shuko Tokuriki ◽

Aiko Igarashi ◽

Takashi Okuno ◽

Genrei Ohta ◽

Takuya Kosaka ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Birth Weight ◽

Cortical Bone ◽

Preterm Infants ◽

Gestational Age ◽

Bone Disease ◽

Metabolic Bone Disease ◽

Bone Thickness ◽

Metabolic Bone

Objective. To use cortical bone thickness (CBT) of the humerus to identify risk factors for the development of metabolic bone disease in preterm infants.Methods. Twenty-seven infants born at <32 weeks of gestational age, with a birth weight of <1,500 g, were enrolled. Humeral CBT was measured from chest radiographs at birth and at 27-28, 31-32, and 36–44 weeks of postmenstrual age (PMA). The risk factors for the development of osteomalacia were statistically analyzed.Results. The humeral CBT at 36–44 weeks of PMA was positively correlated with gestational age and birth weight and negatively correlated with the duration of mechanical ventilation. CBT increased with PMA, except in six very early preterm infants in whom it decreased. Based on logistic regression analysis, gestational age and duration of mechanical ventilation were identified as risk factors for cortical bone thinning.Conclusions. Humeral CBT may serve as a radiologic marker of metabolic bone disease at 36–44 weeks of PMA in preterm infants. Cortical bones of extremely preterm infants are fragile, even when age is corrected for term, and require extreme care to lower the risk of fractures.

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