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Chapter: Paediatrics: Neonatology

Metabolic bone disease

Also known as osteopenia of prematurity, the incidence is 32–90% in pre-term infants (mostly ELBW).

Metabolic bone disease

 

Also known as osteopenia of prematurity, the incidence is 32–90% in pre-term infants (mostly ELBW).

 

Cause

 

Chronic substrate deficiency—usually phosphate, rarely calcium or vita-min D. Risk is increased if:

   prolonged PN;

 

   breastfed (low in phosphate);

 

   chronic diuretic treatment.

 

Presentation

 

   Bone mineral biochemical derangement (see b Investigations); measure serum Ca2+, PO43- and alkaline phosphatase weekly in all infants under 33wks gestation.

   ‘falls’ Linear growth.

   Rib or distal long bone fractures.

 

Investigations

 

   Biochemistry: PO43- <1.2mmol/L; Ca2+ >2.7mmol/L; alkaline phosphatase >1000IU/L.

 

   Bone X-ray: osteoporosis, features of rickets, fractures.

 

   Urine Ca2+/PO43- ratio >1 after 3wks of age (high renal PO43- reabsorption).

 

Treatment

   Oral PO43- 1mmol/kg/day supplement if milk fed.

   Increase TPN Ca2+ and PO43- (consult pharmacist).

 

Prevention

 

In infants <2kg or <33wks gestation:

   Supplement breast milk with oral PO43- 1mmol/kg/day (not required if fed preterm formula as already contains added PO43- );

 

   Oral vitamin D 400IU/day;

 

   Ensure TPN contains Ca2+ 2mmol/kg/day and PO43- 2.5mmol/kg/day (organic phosphate solution avoids mineral precipitation);

 

   10min/day of passive exercise appears beneficial.

 

Prognosis

 

Stature is reduced at age 18mths. Bone mineralization and fracture risk appear to be normal by 2yrs

 

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Paediatrics: Neonatology : Metabolic bone disease |

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Paediatrics: Neonatology


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