Status of osteopenia of prematurity in Sub-Himalayan region of India-a single centre experience

Shanki Kaundal; Seema Sharma; Milap Sharma

doi:10.18203/2349-3291.ijcp20252218

Authors

Shanki Kaundal Department of Paediatrics, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
Seema Sharma Department of Paediatrics, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
Milap Sharma Department of Paediatrics, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20252218

Keywords:

ALP, Bone mineral content, Bone mineral density, Metabolic bone disease, Osteopenia of prematurity

Abstract

Background: Preterm infants are at signiﬁcant risk to develop osteopenia of prematurity (OOP) due to inadequate supply of calcium and phosphorus. Although its exact prevalence is difficult to quantify because of the different methods used to screen infants at risk and also because of the difficulty in the interpretation of these results, it has been steadily increasing with the survival of more immature neonates as a result of advances in neonatal care. Objective of the study was to find out the status of OOP in Sub-Himalayan region of India.

Methods: In this cross-sectional prospective study 101 preterm babies <32 weeks of gestation were evaluated. Biochemical parameters which included serum calcium (Ca), phosphate (P), alkaline phosphatase (ALP), and 25-OH vitamin D3 was done on day 1 of life, then weekly for 4 weeks and then at discharge. X-ray wrist was taken on day 1 of life.

Results: At admission 78 (77.2%) neonates were osteopenic (60.4% with grade-1 and 16.8% grade-2). Calcium levels were not significantly low whereas serum phosphorus levels and vitamin D3 levels were significantly low. Serum ALP levels were found significantly high.

Conclusions: Infants born prematurely have a predisposition to OOP. Serum calcium alone is not a good marker since its level is maintained at expense of loss of bone calcium. But serum phosphorus, ALP and vitamin D are better indicators of disease.

Metrics

Metrics Loading ...

References

Sparks JW. Human intrauterine growth and nutrient accretion. Semin Perinatol. 1984;8(2):74-93.

Koo WW, Sherman R, Succop P, Krug-Wispe S, Tsang RC, Steichen JJ, et al. Fractures andrickets in very low birth weight infants: conservative management and outcome. J Pediatr Orthop. 1989;9(3):326-30. DOI: https://doi.org/10.1097/01202412-198909030-00012

McIntosh N, De Curtis M, Williams J. Failure of mineral supplementation to reduce incidence of rickets in very-low-birth weight infants. Lancet. 1986;2(8513):981-2. DOI: https://doi.org/10.1016/S0140-6736(86)90635-5

Takada M, Shimada M, Hosono S, Tauchi M, Minato M, Takahashi S, et al. Trace elements and mineral requirements for very low birth weight infants in rickets of prematurity. Early Hum Dev. 1992;29(1-3):333-8. DOI: https://doi.org/10.1016/0378-3782(92)90188-M

Abrams SA. In utero physiology: role in nutrient delivery and fetal development for calcium, phosphorus, and vitamin D. Am J Clin Nutr. 2007;85(2):604-7. DOI: https://doi.org/10.1093/ajcn/85.2.604S

Catache M, Leone CR. Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants. Acta Paediatr. 2003;92(1):76-80. DOI: https://doi.org/10.1111/j.1651-2227.2003.tb00473.x

Backström MC, Kouri T, Kuusela AL, Sievänen H, Koivisto AM, Ikonen RS, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr. 2000;89(7):867-73. DOI: https://doi.org/10.1111/j.1651-2227.2000.tb00395.x

Crofton PM, Hume R. Alkaline phosphatase isoenzymes in the plasma of preterm and term infants: serial measurements and clinical correlations. Clin Chem. 1987;33(10):1783-7. DOI: https://doi.org/10.1093/clinchem/33.10.1783

Balasubramanian S, Ganesh R. Vitamin D deficiency in exclusively breastfed infants. Indian J Med Res. 2008;127:250-5.

Bronner F, Salle BL, Putet G, Rigo J, Senterre J. Net calcium absorption in premature infants: results of 103 metabolic balance studies. Am J Clin Nutr. 1992;56:1037-44. DOI: https://doi.org/10.1093/ajcn/56.6.1037

American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics. 1985;75(5):976-86. DOI: https://doi.org/10.1542/peds.75.5.976

Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition.Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142-52. DOI: https://doi.org/10.1542/peds.2008-1862

Abrams SA; Committee on Nutrition. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics. 2013;131(5):1676-83. DOI: https://doi.org/10.1542/peds.2013-0420

Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50(1):85-91. DOI: https://doi.org/10.1097/MPG.0b013e3181adaee0

Betto M, Gaio P, Ferrini I, De Terlizzi F, Zambolin M, Scattolin S, et al. Assessment of bone health in preterm infants through quantitative ultrasound and biochemical markers. J Matern Fetal Neonatal Med. 2014;27(13):1343-7. DOI: https://doi.org/10.3109/14767058.2013.858317

Bishop N. Bone disease in preterm infants. Arch Dis Child. 1989;64(10):1403-9. DOI: https://doi.org/10.1136/adc.64.10_Spec_No.1403

Jahan I, Mannan MA, Dey AC, Dey SK , Choudhury SM, Shahidullah M. Biochemical Bone Markers for Early Detection of Osteopenia of Prematurity. Bangladesh Med Res Counc Bull. 2016;42:104-10. DOI: https://doi.org/10.3329/bmrcb.v42i3.32209

James JR, Congdon PJ, Truscott J, Horsman A, Arthur R. Osteopenia of prematurity. Arch Dis Child. 1986;61(9):871-6. DOI: https://doi.org/10.1136/adc.61.9.871

Mitchell SM, Rogers SP, Hicks PD, Hawthorne KM, Parker BR, Abrams SA. High frequencies of elevated alkaline phosphatase activity and rickets exist in extremely low birth weight infants despite current nutritional support. BMC Pediatr. 2009;29;9:47. DOI: https://doi.org/10.1186/1471-2431-9-47

Binder C, Wild J, Thanhaeuser M, Repa A, Kreissl A. Osteopenic fractures in Preterm Infants<1500 Grams -A Retrospective Data Analysis Over 10 Years at the Medical University of Vienna. J Pediatr Neonatal Care. 2015;2(2):00063. DOI: https://doi.org/10.15406/jpnc.2015.02.00063