Department of Pediatrics-Graduate Medical Education, Seattle Children’s Hospital, The University of Washington School of Medicine, Seattle, Washington, USA.
Pediatrics. 2012 Sep;130(3):e695-8. doi: 10.1542/peds.2011-1295. Epub 2012 Aug 6.
Copper deficiency can cause bone lesions in infants, which might be confused with child abuse. Two extremely low birth weight preterm infants had complicated medical courses requiring prolonged parenteral nutrition for short-gut syndrome, which led to the development of cholestasis. Both had spent their entire lives in the hospital. They had been on prolonged ventilator support for chronic lung disease. They developed signs of copper deficiency between 5 and 6 months of age, initially raising child abuse concerns. Musculoskeletal discomfort led to the recognition of radiographic findings of metabolic bone disease. Included were osteoporosis, metaphyseal changes, and physeal disruptions. Copper levels were low; both low copper parenteral nutrition and gut losses from refeeding diarrhea likely contributed to their deficiency. Therapeutic supplementation with copper corrected their deficits and clinical and radiologic findings. The information from these cases, in particular, their radiologic findings, indicate the need to monitor copper status in at-risk premature infants. These findings may aid prevention and earlier recognition of copper deficiency. Their specific radiologic and clinical findings should aid differentiation of such children from abused infants.
铜缺乏可导致婴儿骨骼病变，可能与虐待儿童相混淆。两名极低出生体重早产儿患有复杂的医学疾病，需要接受短肠综合征的长期肠外营养，导致胆汁淤积。他们都在医院度过了一生。他们因慢性肺病而长期接受呼吸机支持。他们在 5 至 6 个月大时出现铜缺乏的迹象，最初引起虐待儿童的担忧。肌肉骨骼不适导致代谢性骨病的放射学发现。包括骨质疏松症、干骺端变化和骺板破坏。铜水平较低；低铜肠外营养和再喂养腹泻引起的肠道丢失都可能导致其缺乏。补充铜剂治疗纠正了他们的不足和临床及影像学发现。这些病例的信息，特别是他们的影像学发现，表明需要监测高危早产儿的铜状态。这些发现可能有助于预防和更早发现铜缺乏。他们的具体放射学和临床发现应有助于将这些儿童与受虐待的婴儿区分开来。
