Metabolic bone disease is a common problem encountered in premature infants. This entity, also known as osteopenia of prematurity, often leads to morbidity in the form of fractures, which have been described in 30% of infants <1500 g birth weight (BW) [1]. Metabolic bone disease may also worsen respiratory problems in these infants [2]. In its most severe form, rickets may be present, not unlike that seen in older children. Evidence suggests that metabolic bone disease may be associated with decreased linear growth potential even after radiographic and biochemical evidence of disease is corrected [3, 4].
Metabolic bone disease is characterized by decreased bone mineral density which occurs primarily as the result of decreased mineral stores in preterm infants which may be exacerbated by increased mineral demands in the neonatal period. Calcium (Ca) and phosphorus (P) are maximally acquired by the fetus during the third trimester of pregnancy, so premature infants are born with significantly lower mineral stores compared to term infants [5]. Additionally, supplementation of Ca and P in premature infants at the levels needed to match the transplacental accretion in the third trimester has proved challenging, especially in patients who do not tolerate feeds and require prolonged total parenteral nutrition (TPN) [6]. Use of medications such as corticosteroids, methylxanthines, and diuretics also appear to contribute to the development of metabolic bone disease in preterm infants [5].
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Serum alkaline phosphatase activity (APA), serum P, and serum Ca have traditionally been used to screen for metabolic bone disease in preterm infants. Elevated APA and decreased serum P have been shown to correlate with increased risk of osteopenia and rickets in premature infants [7, 8]. Koo et al reported correlations between the presence of skeletal demineralization and decreased birth weight, decreased gestational age, decreased enteral feeds, and elevated serum alkaline phosphatase activity levels in infants <1500 g birth weight [9]. However, the usefulness of APA and serum P as screening tools has been challenged [10]. There are currently no standard recommendations for screening of metabolic bone disease and rickets in preterm infants [11] nor are data available describing the usual values of APA or serum P in extremely low birth weight infants (ELBW, <1000 g BW).
In this study, we sought to determine usual peak serum alkaline phosphatase activity (P-APA) in ELBW infants and determine the frequency at which rickets is diagnosed in these infants.
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This post was last modified on December 11, 2024 10:33 am