Pieltain C, de Halleux V, Senterre Th, Rigo J
Department of Neonatology, University of Liege, CHU de Liège, CHR de la Citadelle, Liège, Belgium.
World Rev Nutr Diet. 2013;106:181-8. doi: 10.1159/000342680. Epub 2013 Feb 11.
Recent advances in neonatal care significantly increases survival rate in preterm and particularly in extremely low birth weight infants (ELBW infants) and nutrition is becoming one of the most challenging issue to improve short and long term health and developmental outcomes. Nutrition is also relevant for bone development and mineralization reducing the risk of osteopenia and metabolic bone disease (MBD). Osteopenia of prematurity is a multifactorial disease including predominantly nutritional but also biomechanical and environmental factors. At birth, the fetal active mineral transfer is interrupted and the preterm becomes related to the parenteral and enteral mineral supplies. On the other hand, physiological adaptation of bone to extra uterine life leads to an increase in bone resorption. This process occurring earlier in preterm than in term infants can be accompanied by an increased risk of bone fragility and fractures. Early provision of highly bioavailable mineral supplies, correction of vitamin D deficiency and the screening of serum phosphorus concentration combined to urinary mineral excretion appears to be helpful for the prevention of MBD. When available, DEXA is more sensitive than ultrasound for quantifying osteopenia in VLBW infants at the time of discharge. Catch-up of mineralization is rapidly observed during the post term period and osteopenia of prematurity seems to be a self-resolving disease although the potential long-term consequences on the attainment of peak bone mass remains uncertain.
新生儿护理的最新进展显著提高了早产儿尤其是极低出生体重儿（ELBW婴儿）的存活率，营养正成为改善短期和长期健康及发育结局最具挑战性的问题之一。营养对于骨骼发育和矿化也很重要，可降低骨质减少和代谢性骨病（MBD）的风险。早产儿骨质减少是一种多因素疾病，主要包括营养因素，但也有生物力学和环境因素。出生时，胎儿活跃的矿物质转运被中断，早产儿依赖肠外和肠内矿物质供应。另一方面，骨骼对宫外生活的生理适应导致骨吸收增加。这个过程在早产儿中比足月儿更早发生，可能伴随着骨骼脆弱和骨折风险增加。早期提供高生物利用度的矿物质供应、纠正维生素D缺乏以及结合尿矿物质排泄情况筛查血清磷浓度，似乎有助于预防MBD。在可行的情况下，出院时双能X线吸收法（DEXA）比超声对极低出生体重儿骨质减少的量化更敏感。尽管早产骨质减少对达到峰值骨量的潜在长期影响仍不确定，但在足月后期可迅速观察到矿化追赶情况，早产骨质减少似乎是一种可自愈的疾病。
