Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
J Pediatr. 2014 Mar;164(3):499-504. doi: 10.1016/j.jpeds.2013.10.089. Epub 2013 Dec 10.
To evaluate bone mineral density (BMD) in preterm neonates at discharge and identify the optimum cutoff values for serum alkaline phosphatase (ALP) and phosphorus (P) concentrations to diagnose the severity of metabolic bone disease of prematurity.
A total of 336 preterm neonates (≤ 31 weeks' gestation and birth weight ≤ 1500 g) were prospectively evaluated for BMD before discharge using dual-energy X-ray absorptiometry.
BMD reference values (at ALP ≤ 500 IU/L) were measured in 279 patients. BMD was classified as poor (<10th percentile) at <0.068 g/cm(2), fair (10th-25th percentile) at 0.068-0.081 g/cm(2), good (25th-75th percentile) at 0.081-0.112 g/cm(2), and very good (>75th percentile) at >0.112 g/cm(2). Increased BMD was associated with a higher birth weight, short duration of parenteral nutrition, and the absence of small for gestational age status, patent ductus arteriosus, intraventricular hemorrhage, and other clinical variables. Metabolic bone disease of prematurity was absent (ALP ≤ 500 IU/L) in 279 cases (83.0%), mild (ALP >500 IU/L and P ≥ 4.5 mg/dL) in 46 cases (13.7%), and severe (ALP >500 IU/L and P <4.5 mg/dL) in 11 cases (3.3%).
A BMD >0.068 g/cm(2) at discharge indicated a 90.3% probability of not developing metabolic bone disease of prematurity. The factors independently associated with increased BMD included higher birth weight, short duration of parenteral nutrition, absence of intraventricular hemorrhage, exclusive feeding of fortified breast milk, and older age at discharge.
评估早产儿出院时的骨密度(BMD),并确定血清碱性磷酸酶(ALP)和磷(P)浓度的最佳截断值,以诊断早产儿代谢性骨病的严重程度。
前瞻性评估了 336 例(≤31 周胎龄和出生体重≤1500g)早产儿出院前的 BMD,使用双能 X 射线吸收法。
在 279 例患者中测量了 BMD 参考值(ALP≤500IU/L)。BMD 分为差(<10 百分位)<0.068g/cm²、中(10-25 百分位)0.068-0.081g/cm²、好(25-75 百分位)0.081-0.112g/cm²和非常好(>75 百分位)>0.112g/cm²。BMD 升高与出生体重较高、静脉营养时间较短以及无小于胎龄儿、动脉导管未闭、颅内出血等临床变量有关。279 例(83.0%)无代谢性骨病(ALP≤500IU/L),46 例(13.7%)轻度(ALP>500IU/L 和 P≥4.5mg/dL),11 例(3.3%)重度(ALP>500IU/L 和 P<4.5mg/dL)。
出院时 BMD>0.068g/cm²提示发生代谢性骨病的概率为 90.3%。与 BMD 升高相关的因素包括出生体重较高、静脉营养时间较短、无颅内出血、强化母乳喂养和出院时年龄较大。