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Liu X, Wang L, Qian M. Analysis of clinical risk factors for metabolic bone disease of prematurity. Front Pediatr 2024; 12:1345878. [PMID: 38818348 PMCID: PMC11137184 DOI: 10.3389/fped.2024.1345878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Objective To analyze clinical data related to preterm infants and identify risk factors for metabolic bone disease of prematurity (MBDP). Methods This study involved 856 newborns with a gestational age of less than 37 weeks or a weight of less than 1,500g at the Second Hospital of Jilin University. Multifactorial analysis was performed using logistic regression models to explore the risk factors for MBDP. Linear regression was used to investigate the factors affecting the time of alkaline phosphatase (ALP) exceedance and the peak value of ALP in the MBDP group. Results In the MBDP group, ALP excesses occurred in preterm infants at an average of 39.33 days after birth, and the mean value of peak ALP was 691.41 IU/L. Parenteral nutrition and the application of assisted ventilation were independent risk factors for MBDP, with ORs of 1.02 and 1.03 respectively. Gestational age was found to be a protective factor for earlier time of onset of ALP exceedance (β = 2.24,) and the increase in the peak value of ALP (β = -16.30). Conclusion Parenteral nutrition and the application of assisted ventilation are independent risk factors for MBDP. Gestational age is a major factor influencing the time of onset of ALP exceedance and the peak value of ALP in infants with MBDP.
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Affiliation(s)
- Xiumin Liu
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Ling Wang
- Chongqing Yubei Center for Disease Control and Prevention, Chongqing, China
| | - Min Qian
- Department of Neonatology, The Second Hospital of Jilin University, Changchun City, Jilin Province, China
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Perrone S, Caporilli C, Grassi F, Ferrocino M, Biagi E, Dell’Orto V, Beretta V, Petrolini C, Gambini L, Street ME, Dall’Asta A, Ghi T, Esposito S. Prenatal and Neonatal Bone Health: Updated Review on Early Identification of Newborns at High Risk for Osteopenia. Nutrients 2023; 15:3515. [PMID: 37630705 PMCID: PMC10459154 DOI: 10.3390/nu15163515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Bone health starts with maternal health and nutrition, which influences bone mass and density already in utero. The mechanisms underlying the effect of the intrauterine environment on bone health are partly unknown but certainly include the 'foetal programming' of oxidative stress and endocrine systems, which influence later skeletal growth and development. With this narrative review, we describe the current evidence for identifying patients with risk factors for developing osteopenia, today's management of these populations, and screening and prevention programs based on gestational age, weight, and morbidity. Challenges for bone health prevention include the need for new technologies that are specific and applicable to pregnant women, the foetus, and, later, the newborn. Radiofrequency ultrasound spectrometry (REMS) has proven to be a useful tool in the assessment of bone mineral density (BMD) in pregnant women. Few studies have reported that transmission ultrasound can also be used to assess BMD in newborns. The advantages of this technology in the foetus and newborn are the absence of ionising radiation, ease of use, and, above all, the possibility of performing longitudinal studies from intrauterine to extrauterine life. The use of these technologies already in the intrauterine period could help prevent associated diseases, such as osteoporosis and osteopenia, which are characterised by a reduction in bone mass and degeneration of bone structure and lead to an increased risk of fractures in adulthood with considerable social repercussions for the related direct and indirect costs.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Caporilli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Federica Grassi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Mandy Ferrocino
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Eleonora Biagi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Valentina Dell’Orto
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Virginia Beretta
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Lucia Gambini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Maria Elisabeth Street
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Andrea Dall’Asta
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Tullio Ghi
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
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Liang L, Zhuo R, Zhu H, Xie Q, Yang M, Liu Y, Lin J. Establishment of a nomogram model for predicting metabolic bone disease in preterm infants: A case‒control study. Eur J Pediatr 2023:10.1007/s00431-023-04985-3. [PMID: 37184649 DOI: 10.1007/s00431-023-04985-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate risk factors for metabolic bone disease (MBD) in preterm infants and establish a nomogram model for predicting MBD risk. METHODS A total of 1104 preterm infants were enrolled, among whom 809 were included in the modelling set and 295 were included in the validation set. The modelling set was divided into MBD (n = 185) and non-MBD (n = 624) groups. A multivariate logistic regression analysis was used to investigate the independent risk factors for MBD. R software was used to plot the nomogram model, which was then validated by the data of the validation set. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the nomogram model's performance, and the clinical decision curve was used to assess the clinical practicability of the model. RESULTS Gestational age, time of trophic feeding initiation, parenteral nutrition duration, necrotizing enterocolitis, bronchopulmonary dysplasia, cholestasis and sepsis were independent risk factors for MBD in preterm infants (P < 0.05). The ROC curve of the modelling set had an area under the curve (AUC) of 0.801; the risk prediction value of 0.196 corresponding to the maximum Youden index was the best value, and the prediction critical value was 125 points. The ROC curve of the validation set had an AUC of 0.854. The calibration curve analysis showed good accuracy and consistency between the model's predicted and actual values. CONCLUSIONS The nomogram model provides an efficient tool for the early assessment of MBD risk. Preterm infants with scores ≥ 125 should receive close attention and interventions in the early stage. WHAT IS KNOWN • The incidence and severity of MBD are inversely proportional to gestational age and birth weight. Bone loss can lead to prolonged hospital stay, ventilator dependence, pathological fractures and short stature. WHAT IS NEW • Gestational age, time of trophic feeding initiation, parenteral nutrition duration, necrotizing enterocolitis, bronchopulmonary dysplasia, cholestasis and sepsis were independent risk factors for MBD in preterm infants. The nomogram model provides an efficient tool for the early assessment of MBD risk.
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Affiliation(s)
- Liyu Liang
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Ruiyan Zhuo
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Hui Zhu
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
| | - Qinmei Xie
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Meijun Yang
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Yongle Liu
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Jinwen Lin
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
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Azangou-Khyavy M, Saeedi Moghaddam S, Mohammadi E, Shobeiri P, Rashidi MM, Ahmadi N, Shahsavan S, Shirzad Moghaddam Z, Sohrabi H, Pourghasem F, Kalantar R, Ghaffari A, Hashemi SM, Rezaei N, Larijani B. Attributable disease burden related to low bone mineral density in Iran from 1990 to 2019: results from the Global Burden of Disease 2019. Arch Osteoporos 2022; 17:140. [PMID: 36355233 DOI: 10.1007/s11657-022-01180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Low bone mineral density (BMD) including low bone mass and osteoporosis is a bone state that carries the risk of fractures and the consequent burden. Since Iran has an aging population and is considered a high-risk country regarding fracture, the objective of this study was to report the low BMD attributable burden in Iran from 1990 to 2019 at national and subnational levels. MATERIALS AND METHODS In this study, the Global Burden of Disease (GBD) study 2019 estimates of exposure value and attributable burden were used. For each risk-outcome pair, following the estimation of relative risk, exposure level, and the Theoretical Minimum Risk Exposure Level (TMREL), the Population Attributable Fractions (PAFs) and attributable burden were computed. The Summary Exposure Value (SEV) index was also computed. RESULTS Although the age-standardized DALYs and deaths decreased (- 41.0 [95% uncertainty interval: - 45.7 to - 33.2] and - 43.3 [- 48.9 to - 32.5]), attributable all age numbers in Iran increased from 1990 to 2019 (64.3 [50.6 to 89.1] and 66.8 [49.7 to 102.0]). The male gender had a higher low BMD attributed burden in Iran at national and subnational levels except for Tehran. Among low BMD-associated outcomes, motor vehicle road injuries and falls accounted for most of the low BMD-attributed burden in Iran. The SEV for low BMD remained constant from 1990 to 2019 in the country and females had higher SEVs. CONCLUSION Low BMD and the associated outcomes has to gain attention in Iran's health system due to an aging population. Hence, timely interventions by health systems and the population at stake might assist in reducing the burden attributed to low BMD.
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Affiliation(s)
- Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Shahsavan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Shirzad Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanye Sohrabi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Pourghasem
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Kalantar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aydin Ghaffari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Melika Hashemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Wang J, Zhao Q, Chen B, Sun J, Huang J, Meng J, Li S, Yan W, Ren C, Hao L. Risk factors for metabolic bone disease of prematurity: A meta-analysis. PLoS One 2022; 17:e0269180. [PMID: 35696368 PMCID: PMC9191712 DOI: 10.1371/journal.pone.0269180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/16/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the risk factors for metabolic bone disease of prematurity (MBDP), and to provide a reference for the prevention of MBDP. Methods The databases including China Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Data, and Weipu Periodical Database, PubMed, Web of Science, Embase, Cochrane Library and other databases were searched for studies on the risk factors for MBDP published up to June 18, 2021. RevMan 5.3 and Stata 14.1 software were used to perform a Meta analysis. Results A total of 15 articles were included, including 13 case-control studies, 1 current investigation, and 1 retrospective cohort study. There were 1,435 cases in the case group and 2,057 cases in the control group, with a total sample size of 3,492 cases. Meta analysis showed that risk factors for MBDP include birth weight <1000g (OR = 6.62, 95%CI: 2.28–19.25), gestational age <32 weeks (OR = 2.73, 95%CI: 1.07–6.95), septicemia (OR = 2.53, 95%CI: 1.69–3.79), parenteral nutrition time (OR = 4.04, 95%CI: 1.72–9.49), cholestasis (OR = 3.50, 95%CI: 1.49–8.23), intrauterine growth retardation (OR = 6.89, 95%CI: 3.81–12.44), while the birth weight(OR = 0.44, 95%CI: 0.21–0.90) and gestational age (OR = 0.57, 95%CI: 0.44–0.73)are the protective factors of MBDP. Conclusion Factors like birth weight <1000g, gestational age <32 weeks, septicemia, parenteral nutrition time, cholestasis, and intrauterine growth retardation may increase the risk of metabolic bone disease of prematurity.
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Affiliation(s)
- Jie Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Qian Zhao
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Baochang Chen
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jingfei Sun
- People’s Hospital of Zhengding County, Shijiazhuang, Hebei Province, China
| | - Jiayu Huang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jinfeng Meng
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Shangbin Li
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Weichen Yan
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Changjun Ren
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- * E-mail: (CR); (LH)
| | - Ling Hao
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- * E-mail: (CR); (LH)
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Torró-Ferrero G, Fernández-Rego FJ, Gómez-Conesa A. Physical Therapy to Prevent Osteopenia in Preterm Infants: A Systematic Review. CHILDREN-BASEL 2021; 8:children8080664. [PMID: 34438555 PMCID: PMC8391284 DOI: 10.3390/children8080664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Background: During the last trimester of pregnancy, about 80% of the infant’s calcium is incorporated, and for this reason, preterm infants have less bone mineralization compared to those born at term. The aim of the present systematic review was to identify, evaluate and summarize the studies that deal with the effect of physiotherapy modalities in the prevention and treatment of osteopenia in preterm infants. Methods: A comprehensive search (09/2019–02/2021) using PubMed, Web of Science, SCOPUS, ProQuest, SciELO, Latindex, ScienceDirect, PEDro and ClinicalTrials.gov was carried out. The following data were extracted: The number of participants, characteristics of the participants, design, characteristics of the intervention, outcome measures, time of evaluation and results. A non-quantitative synthesis of the extracted data was performed. The methodological quality and risk of bias were assessed using a PEDro scale and ROB-2 scale, respectively. Results: A total of 16 studies were analyzed, presenting a methodological quality that ranged from 3 to 8 points, and all showed some concerns regarding their risk of bias. Almost all studies (15/16) used passive mobilizations with joint pressure to prevent osteopenia, but they differed in the intensity and frequency of application. Conclusions: A daily exercise program of passive mobilizations with joint pressure, improves bone mineralization in preterm infants admitted to neonatal units.
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Affiliation(s)
- Galaad Torró-Ferrero
- International School of Doctorate of the Univesity of Murcia (EIDUM), University of Murcia, 30100 Murcia, Spain
- Correspondence: ; Tel.: +34-685-30-69-37
| | | | - Antonia Gómez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain;
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Kavurt S, Demirel N, Yücel H, Unal S, Yıldız YT, Bas AY. Evaluation of radiologic evidence of metabolic bone disease in very low birth weight infants at fourth week of life. J Perinatol 2021; 41:2668-2673. [PMID: 33986471 PMCID: PMC8117125 DOI: 10.1038/s41372-021-01065-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 12/02/2022]
Abstract
AIM The aim of this study is to determine the incidence of metabolic bone disease (MBD) and assess the risk factors for development radiologic evidence of MBD. METHODS Preterm infants with gestational age ≤32 weeks and birth weight ≤1500 g were included in this prospective study. Metabolic bone disease was defined as hypophosphatemia (phosphorus levels <4 mg/dl), ALP levels >450 U/L, or radiologic findings of MBD at four weeks of age. RESULTS The study included 254 infants (gestational age: 29 (27-30) weeks, birth weight: 1130 g (960-1300)). Metabolic bone disease was diagnosed in 96 patients (37%); 48 infants had only radiologic evidence of MBD, 24 infants had only biochemical diagnosis of MBD, and 24 infants had both radiologic evidence of MBD and biochemical diagnosis of MBD. CONCLUSIONS Our results showed that radiologic evidence of MBD existed in some infants with normal biochemical results. That finding may guide further development of screening programs for MBD.
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Affiliation(s)
- Sumru Kavurt
- Department of Neonatology, Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital, Ankara, Turkey.
| | - Nihal Demirel
- grid.449874.20000 0004 0454 9762Department of Neonatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hüsniye Yücel
- Department of Pediatrics, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sezin Unal
- grid.414641.20000 0004 0419 069XDepartment of Neonatology, Etlik Zubeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Yasemin Taşcı Yıldız
- Department of Radiology, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ahmet Yagmur Bas
- grid.449874.20000 0004 0454 9762Department of Neonatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Llorente-Pelayo S, Docio P, Lavín-Gómez BA, García-Unzueta MT, de las Cuevas I, de la Rubia L, Cabero-Pérez MJ, González-Lamuño D. Modified Serum ALP Values and Timing of Apparition of Knee Epiphyseal Ossification Centers in Preterm Infants with Cholestasis and Risk of Concomitant Metabolic Bone Disease of Prematurity. Nutrients 2020; 12:nu12123854. [PMID: 33348603 PMCID: PMC7766077 DOI: 10.3390/nu12123854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Abstract
The usefulness of serum alkaline phosphatase (ALP) and phosphorous in screening and monitoring of metabolic bone disease of prematurity (MBDP) still has some limitations, especially in preterm infants with concomitant conditions such as cholestasis. We aimed to assess a modification of serum ALP (M-ALP) as a biomarker for MBDP in preterm infants, and the use of ultrasound monitoring for the apparition of knee ossification centers as marker of bone mineralization. Biochemical and clinical registers were taken from 94 preterm newborns <32 weeks. A significant correlation existed between serum ALP and direct bilirubin (DB), expressed by the regression equation: M-ALP (IU/L) = 302.1 + 96.9 (DB (mg/dL)). The ratio ALP/M-ALP > 1 was demonstrated to be more specific (87.5%) in the diagnosis of MBDP than the cut-off value of serum ALP > 500 IU/L (62.5%). ALP/M-ALP > 1 showed 100% sensitivity and specificity for the diagnosis of MBDP, and a good correlation with specific bone ALP (B-ALP). Patients with the knee nucleus by post-menstrual week 37 had lower B-ALP compared to patients with no nucleus, and no patients with MBDP presented the nucleus by the 40th week. In the absence of reliable specific B-ALP, reinterpreting serum ALP values by M-ALP plus monitoring of knee ossification centers contribute to better management of MBDP in preterm infants with cholestasis.
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Affiliation(s)
- Sandra Llorente-Pelayo
- Pediatric Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain; (S.L.-P.); (P.D.)
| | - Pablo Docio
- Pediatric Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain; (S.L.-P.); (P.D.)
| | - Bernardo A. Lavín-Gómez
- Biochemical Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain; (B.A.L.-G.); (M.T.G.-U.)
| | - María T. García-Unzueta
- Biochemical Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain; (B.A.L.-G.); (M.T.G.-U.)
| | - Isabel de las Cuevas
- Neonatology Unit, Pediatric Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain;
- Departmento de Ciencias Médicas y Quirúrgicas, University of Cantabria, 39005 Santander, Spain;
| | - Luis de la Rubia
- Departmento de Ciencias Médicas y Quirúrgicas, University of Cantabria, 39005 Santander, Spain;
- Gastroenterology and Hepatology Unit, Pediatric Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain
| | - María J. Cabero-Pérez
- Pediatric Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain; (S.L.-P.); (P.D.)
- Departmento de Ciencias Médicas y Quirúrgicas, University of Cantabria, 39005 Santander, Spain;
- Correspondence: (M.J.C.-P.); (D.G.-L.); Tel.: +34-942-202604 (D.G.-L.)
| | - Domingo González-Lamuño
- Pediatric Department, University Hospital Marqués de Valdecilla—Research Institute Valdecilla (IDIVAL), 39008 Santander, Spain; (S.L.-P.); (P.D.)
- Departmento de Ciencias Médicas y Quirúrgicas, University of Cantabria, 39005 Santander, Spain;
- Correspondence: (M.J.C.-P.); (D.G.-L.); Tel.: +34-942-202604 (D.G.-L.)
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Chacham S, Pasi R, Chegondi M, Ahmad N, Mohanty SB. Metabolic Bone Disease in Premature Neonates: An Unmet Challenge. J Clin Res Pediatr Endocrinol 2020; 12:332-339. [PMID: 31674171 PMCID: PMC7711645 DOI: 10.4274/jcrpe.galenos.2019.2019.0091] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Metabolic bone disease (MBD) is an important cause of morbidity in premature, very low birth weight (VLBW) and sick infants and, if left undiagnosed, may lead to structural deformities and spontaneous fractures. MBD is defined as impaired bone mineralization in a neonate with lower than expected bone mineral levels in either a fetus or a neonate of comparable gestational age and/or weight, coupled with biochemical abnormalities with or without accompanying radiological manifestations. MBD has been reported to occur in 16% to 40% of extremely low birth weight neonates and presents by 6-16 weeks after birth. Insufficient calcium and phosphorous stores during the phase of accelerated growth predispose to MBD in neonates along with the use of some medications such as caffeine or steroids, prolonged parenteral nutrition and chronic immobilization. Enhanced physical activity in preterm infants facilitates bone mineralization and weight gain. Biochemical abnormalities tend to worsen significantly, as the severity of disease progresses. These abnormalities may include hypocalcemia, hypophosphatemia, hyperphosphatasia and secondary hyperparathyroidism. In addition, urinary phosphate wasting and hypovitaminosis D can be additional complications. Conversely, biochemical abnormalities may not be accompanied by rachitic changes. Newer diagnostic modalities include non-invasive bone densitometry by quantitative ultrasound over the mid-tibial shaft. The management of MBD includes adequate calcium, phosphorous and vitamin D supplementation, along with optimum nutrition and physical activity. Similarly, preventive strategies for MBD should target nutritional enhancement in combination with enhanced physical activity. MBD usually results in preventable morbidity in preterm and VLBW neonates. Treatment consists of optimum nutritional supplementation and enhanced physical activity.
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Affiliation(s)
- Swathi Chacham
- All India Institute of Institute of Medical Sciences, Rishikesh, India,* Address for Correspondence: All India Institute of Institute of Medical Sciences, Rishikesh, India Phone: +91-98494-47306 E-mail:
| | - Rachna Pasi
- Himalayan Institute of Medical Sciences, Dehradun, India
| | | | - Najeeb Ahmad
- All India Institute of Institute of Medical Sciences, Rishikesh, India
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Cooper DM, Girolami GL, Kepes B, Stehli A, Lucas CT, Haddad F, Zalidvar F, Dror N, Ahmad I, Soliman A, Radom-Aizik S. Body composition and neuromotor development in the year after NICU discharge in premature infants. Pediatr Res 2020; 88:459-465. [PMID: 31926484 PMCID: PMC7351612 DOI: 10.1038/s41390-020-0756-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 01/01/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypothesis: neuromotor development correlates to body composition over the first year of life in prematurely born infants and can be influenced by enhancing motor activity. METHODS Forty-six female and 53 male infants [27 ± 1.8 (sd) weeks] randomized to comparison or exercise group (caregiver provided 15-20 min daily of developmentally appropriate motor activities) completed the year-long study. Body composition [lean body and fat mass (LBM, FM)], growth/inflammation predictive biomarkers, and Alberta Infant Motor Scale (AIMS) were assessed. RESULTS AIMS at 1 year correlated with LBM (r = 0.32, p < 0.001) in the whole cohort. However, there was no effect of the intervention. LBM increased by ~3685 g (p < 0.001)); insulin-like growth factor-1 (IGF-1) was correlated with LBM (r = 0.36, p = 0.002). IL-1RA (an inflammatory biomarker) decreased (-75%, p < 0.0125). LBM and bone mineral density were significantly lower and IGF-1 higher in the females at 1 year. CONCLUSIONS We found an association between neuromotor development and LBM suggesting that motor activity may influence LBM. Our particular intervention was ineffective. Whether activities provided largely by caregivers to enhance motor activity in prematurely born infants can affect the interrelated (1) balance of growth and inflammation mediators, (2) neuromotor development, (3) sexual dimorphism, and/or (4) body composition early in life remains unknown.
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Affiliation(s)
- Dan M Cooper
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA.
| | - Gay L Girolami
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Brenda Kepes
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Annamarie Stehli
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Candice Taylor Lucas
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Fadia Haddad
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Frank Zalidvar
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Nitzan Dror
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Irfan Ahmad
- Children's Hospital of Orange County, Orange, CA, USA
| | | | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
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Korčeková Z, Korček P, Čunát V, Staníčková Z, Zemanová P, Straňák Z. Tibial speed of sound changes in preterm infants during the first year of life. Bone 2020; 132:115191. [PMID: 31846825 DOI: 10.1016/j.bone.2019.115191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Metabolic bone disease of prematurity (MBD) frequently affects preterm infants. The accurate diagnosis of the MBD remains a challenging issue despite characteristic clinical, laboratory and imaging features. Recently, non-invasive quantitative ultrasound (QUS) measuring speed of sound (SOS) has been applied to assess bone status. Limited data are available on comparison of QUS among preterm infants. OBJECTIVE To evaluate development of tibial bone SOS values in preterm infants during the first year of life and compare the SOS values among different birth weight categories. METHODS QUS was used in 153 infants below 34 weeks of gestation. The study group was divided into 3 subgroups based on birth weight (BW): ≤1000 g, 1001-1500 g and >1500 g. SOS measurement was performed at 6 and 12 months of corrected age (CA). RESULTS Overall, we found significant increase in mean tibial SOS between 6 and 12 months of CA (3004 ± 123 vs 3253 ± 109 m/s, p = 0.001). There were significant differences in SOS among birth weight categories at 6 months of CA (p = 0.045). However, these differences were not statistically significant at 12 months of CA (p = 0.289). The infants ≤ 1000 g scored the highest SOS values at both time points. CONCLUSIONS Tibial SOS significantly increases during infancy in preterm newborns. Significant variation exists in SOS at 6 months, but not at 12 months of corrected age according to BW. Moreover, inverse correlation between BW and SOS indicating better bone status was revealed in extremely low birth weight infants at both 6 or at 12 months of CA.
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Affiliation(s)
- Zuzana Korčeková
- Institute for the care of mother and child - Neonatology, Podolské nábřeží 157/36, Prague 14700, Czech Republic
| | - Peter Korček
- Institute for the care of mother and child - Neonatology, Podolské nábřeží 157/36, Prague 14700, Czech Republic; 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague 10000, Czech Republic.
| | - Václav Čunát
- Institute for the care of mother and child - Neonatology, Podolské nábřeží 157/36, Prague 14700, Czech Republic
| | - Zuzana Staníčková
- Institute for the care of mother and child - Neonatology, Podolské nábřeží 157/36, Prague 14700, Czech Republic
| | - Patrícia Zemanová
- Institute for the care of mother and child - Neonatology, Podolské nábřeží 157/36, Prague 14700, Czech Republic
| | - Zbyněk Straňák
- Institute for the care of mother and child - Neonatology, Podolské nábřeží 157/36, Prague 14700, Czech Republic; 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague 10000, Czech Republic
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Sezer Efe Y, Erdem E, Güneş T. The Effect of Daily Exercise Program on Bone Mineral Density and Cortisol Level in Preterm Infants with Very Low Birth Weight: A Randomized Controlled Trial. J Pediatr Nurs 2020; 51:e6-e12. [PMID: 31285069 DOI: 10.1016/j.pedn.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE This randomized controlled double-blinded experimental study was carried out to determine the effects of the daily exercise program on bone mineral density and cortisol level in preterm infants with VLBW matched for birth weight, gestation week, and gender. DESIGN AND METHODS The study was carried out with preterm infants (n = 24) hospitalized in the NICU of a tertiary hospital. Ethical committee approval, institutional permission, parental written consent were obtained. A daily exercise program was implemented in preterm infants in the exercise group for 30 days, once a day, and continuing for 7-10 min. Before and after the study the following were evaluated in preterm infants in the exercise and control group: anthropometric measurements, tibia speed of sound (SOS) for bone mineral density, serum cortisol levels. RESULTS Serum cortisol levels (p = 0.05) were decreased, bone SOS values in the exercise group were increased (p = 0.009), after the study. The difference between pre-, post-study bone SOS and serum cortisol values of infants in the exercise group were high (p > 0.05). Percentage increases in anthropometric values in the exercise group were higher than the control group after the study (for all; p > 0.05). CONCLUSIONS The daily exercise program has positive effect on bone SOS and serum cortisol values in preterm infants. Neonatal nurses can implement the daily exercise program in clinical practice. Trial registration numberClinicaltrials.govNCT03773679.
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Affiliation(s)
- Yağmur Sezer Efe
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Emine Erdem
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Tamer Güneş
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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Current status in therapeutic interventions of neonatal bone mineral metabolic disorders. Semin Fetal Neonatal Med 2020; 25:101075. [PMID: 31879202 DOI: 10.1016/j.siny.2019.101075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neonatal care has significantly improved in the past decade with improved survival of preterm and sick neonates. Similarly, the field of bone and mineral disorders is continuing to accelerate with better understanding of pathophysiology and genetic basis of diseases, as well as availability of newer diagnostic and therapeutic modalities. In this extensive and rapidly expanding field, metabolic bone disease specialists are frequently called upon to translate progress into better care for neonates with bone and mineral disorders. Accordingly, this chapter provides a review of clinical manifestations and evidence-based investigation and management (where available) of common, rare and ultra-rare disorders of bone and mineral metabolism manifesting in the neonatal period. Besides medical treatment we emphasise the crucial role of the multidisciplinary team, which include physical therapists, occupational therapists and dieticians, in the care of neonates with bone disorders such as osteogenesis imperfecta and achondroplasia.
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Abstract
Bone remodeling is a complex process which integrates different stimuli factors such as mechanical, nutritional and hormonal factors as well as cytokines and growth factors. Bone health depends on an adequate balance between all these factors. The typical bone pathology of the newborn is the metabolic bone disease of prematurity, favored by a lack of mineral accretion in the third trimester of gestation. The intrinsic defects of the bone tissue (primary osteoporosis) are usually of genetic or idiopathic origin and can affect both the term and the preterm newborn. Other risk factors for osteopenia (secondary osteoporosis) include maternal or gestational factors, nutritional deficits (calcium, phosphorus, vitamin D), endocrinological alterations, use of certain medications antagonistic to bone metabolism, mechanical factors and chronic diseases (renal or hepatic insufficiency, intestinal malabsorption, collagen or metabolic diseases). This review examines the risk factors of developing bone metabolic disorders in neonates.
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Affiliation(s)
- Alicia Montaner Ramón
- Neonatology Unit, Hospital Infantil Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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