2013, Number 6
<< Back Next >>
Bol Med Hosp Infant Mex 2013; 70 (6)
Time of onset of osteopenia in preterm newborns in a neonatology service
Tapia-Rombo CA, Villalobos-Granja KP, Ramírez-Pérez J, Uscanga-Carrasco H, Robles-Espinosa LA
Language: Spanish
References: 29
Page: 432-440
PDF size: 368.39 Kb.
ABSTRACT
Introduction. Osteopenia is a decrease in bone density secondary to low bone mineralization and can present as rickets, osteomalacia and osteoporosis. The aim of this study is to detect when osteopenia is presented in preterm newborns (PTNB) of a neonatal ward.
Methods. We carried out an observational, prospective, comparative clinical trial (study cohort) that included 30 PTNB admitted from November 2010 to August 2011 and who met the selection criteria. Alkaline phosphatase levels were considered elevated from 280 IU/l. Serum Ca, P, and alkaline phosphatase were determined in all patients. X-rays of long bones at 2, 4, 6 and 8 weeks after admission were taken. Statistical analysis was performed using descriptive and inferential statistics. Significance levels were set at
p ‹0.05.
Results. The study population consisted of 30 PNB with a median gestational age of 29 weeks and median birth weight of 1055 g. Parenteral and enteral nutrition (mixed) was managed in all patients. Radiological changes suggestive of osteopenia were reported in 83.3% of patients during the first 2 weeks of study and at the end of the study in 86.7% of patients (n = 26). The median age of detection of osteopenia was 19 days of life.
Conclusions. Osteopenia of prematurity occurs at approximately the third week after birth. These results present a different picture from that reported in the literature since the time of reporting these data. Preventing bone disease should be done early
REFERENCES
Rubin LP. Trastornos del metabolismo del calcio y del fósforo. En: Taeusch HW, Ballard RAS, eds. Tratado de Neonatología de Avery. Madrid: Ediciones Harcourt SA; 2000. pp. 1189-1206.
Hospital Británico. Departamento de Pediatría. Unidad Neonatal. Osteopenia del prematuro. Arch Pediatr Urug 2006;77:290-292.
Brooke OG, Lucas A. Metabolic bone disease in preterm infants. Arch Dis Child 1985;60:682-685.
McIntosh N, Livesey A, Brooke OG. Plasma 25-hydroxyvitamin D and rickets in infants of extremely low birthweight. Arch Dis Child 1982;57:848-850.
Rigo J, De Curtis M, Pieltain C, Picaud JC, Salle BL, Senterre J. Bone mineral metabolism in the micropremie. Clin Perinatol 2000;27:147-170.
Prestidge LL, Schanler RJ, Shulman RJ, Burns PA, Laine LL. Effect of parenteral calcium and phosphorus therapy on mineral retention and bone mineral content in very low birth weight infants. J Pediatr 1993;122(5 Pt 1):761-768.
Shrivastava A, Lyon A, McIntosh N. The effect of dexamethasone on growth, mineral balance and bone mineralization in preterm infants with chronic lung disease. Eur J Pediatr 2000;159:380-384.
Moyer-Mileur L, Luetkemeier M, Boomer L, Chan GM. Effect of physical activity on bone mineralization in premature infants. J Pediatr 1995;127:620-625.
Litmanovitz I, Dolfin T, Friedland O, Arnon S, Regev R, Shainkin-Kestenbaum R, et al. Early physical activity intervention prevents decrease of bone strength in very low birth weight infants. Pediatrics 2003;112(1 Pt 1):15-19.
Moyer–Mileur LJ, Brunstetter V, McNaught TP, Gill G, Chang GM. Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants. Pediatrics 2000;106:1088-1092.
Eliakim A, Nemet D. Osteopenia of prematurity —the role of exercise in prevention and treatment. Pediatr Endocrinol Rev 2005;2:675-682.
Eliakim A, Shiff Y, Nemet D, Dolfin T. The effect of neonatal sepsis on bone turnover in very-low birth weight premature infants. J Pediatr Endocrinol Metab 2003;16:413-418.
Chan GM. Growth and bone mineral status of discharged very low birth weight infants fed different formulas or human milk. J Pediatr 1993;123:439-443.
Rowe J, Rowe D, Horak E, Spackman T, Saltzman R, Robinson S, et al. Hypophosphatemia and hypercalciuria in small premature infants fed human milk: evidence for inadequate dietary phosphorus. J Pediatr 1984;104:112-117.
Miller ME. The bone disease of preterm birth: a biomechanical perspective. Pediatr Res 2003;53:10-15.
Steichen JJ, Gratton TL, Tsan RC. Osteopenia of prematurity: the cause and possible treatment. J Pediatr 1980;96(3 Pt 2):528-534.
Kulkarni PB, Hall RT, Rhodes PG, Sheehan MB, Callenbach JC, Germann DR, et al. Rickets in very low-birth-weight infants. J Pediatr 1980;96:249-252.
Campbell D, Fleischman AR. Rickets of prematurity: controversies in causation and prevention. Clin Perinatol 1988;15:879-890.
James JA, Mayne PD, Barnes IC, Kovar IZ. Growth velocity and plasma alkaline phosphatase activity in the preterm infant. Early Hum Dev 1985;11:27-32.
Kovar I, Mayne P, Barltrop D. Plasma alkaline phosphatase activity: a screening test for rickets in preterm neonates. Lancet 1982;1:308-310.
Lucas A, Brooke OG, Baker BA, Bishop N, Morley R. High alkaline phosphatase activity and growth in preterm neonates. Arch Dis Child 1989;64:902-909.
Glass EJ, Hume R, Hendry GM, Strange RC, Forfar JO. Plasma alkaline phosphatase activity in rickets of prematurity. Arch Dis Child 1982;57:373-376.
Faerk J, Peitersen B, Petersen S, Michaelsen KF. Bone mineralization in premature infants cannot be predicted from serum alkaline phosphatase or serum phosphate. Arch Dis Child Fetal Neonatal Ed 2002;87:F133-F136.
Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991;119:417-423.
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 g. J Pediatr 1978;92:529-534.
Chang GM, Mileur L, Hansen JW. Effects of increased calcium and phosphorus formulas and human milk on bone mineralization in preterm infants. J Pediatr Gastroenterol Nutr 1986;5:444-449.
Gandy GM, Roberton NC. Neonatología. México D.F.: El Manual Moderno; 1989. p. 324.
Román NA, Wilson SJ, Beca IJP, Cortés EJM, Polette BV, Espíndola AAM. Fosfatasas alcalinas en el estudio de osteopenia del prematuro. Rev Chil Pediatr 1993;64: 359-363.
Ceriani-Cernadas JM, Fustiñana CA, Mariani G, Jenik A, Lupo EA. Neonatología Práctica. Buenos Aires: Editorial Médica Panamericana; 2009. p. 260.