Mannan M A, Jahan I, Rahman M Z, Hasan Z, Dey A C, Shahidullah M
Professor Md Abdul Mannan, Professor, Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Mymensingh Med J. 2015 Jul;24(3):631-7.
The continuous advances in intensive care have led to increased survival of premature infants. As a consequence, the problem of less imminent, slowly progressing disorders such as osteopenia of prematurity has been emerging. Osteopenia of prematurity (OOP) also called metabolic bone disease of prematurity (MBD) or rickets of prematurity is characterized by a reduction in bone mineral content usually manifest between 6th to 12th weeks of corrected gestational age. It occurs in up to 55% of infants born with weight <1000gm and 23% of infants weighing <1500gm. Clinical features of osteopenia of prematurity are mostly non-specific often appears as a late symptoms. Several biochemical markers have frequently been used as screening tools and diagnostic markers, but timing of measurements and the levels at which treatment should be initiated vary widely. Dual energy X-ray absorptiometry (DEXA) and Quantitative ultrasnogram are important diagnostic tool. Standard X-ray, a widely accepted but cannot detect osteopenia unless 20% loss of bone mineralization. The treatment of osteopenia includes provision of adequate mineral supplementation. Monitoring of serum and urinary markers are mandatory. The focus on prevention has largely centered on providing adequate intake of phosphorus and calcium but more research is needed. Till date there are neither enough data regarding clinical risk factors, valid biochemical markers which can detect premature babies at risk of osteopenia nor supplementation as well as appropriate timely management protocol is practicing in Bangladesh.
重症监护技术的不断进步提高了早产儿的存活率。因此，诸如早产儿骨质减少等不太紧急、进展缓慢的疾病问题日益凸显。早产儿骨质减少（OOP），也称为早产儿代谢性骨病（MBD）或早产儿佝偻病，其特征是骨矿物质含量降低，通常在矫正胎龄的第6至12周表现出来。体重<1000克的新生儿中高达55%会出现这种情况，体重<1500克的婴儿中有23%会出现。早产儿骨质减少的临床特征大多不具特异性，常表现为晚期症状。几种生化标志物经常被用作筛查工具和诊断标志物，但测量时间和开始治疗的水平差异很大。双能X线吸收法（DEXA）和定量超声检查是重要的诊断工具。标准X线检查虽被广泛接受，但除非骨矿化损失20%，否则无法检测出骨质减少。早产儿骨质减少的治疗包括提供充足的矿物质补充。必须监测血清和尿液标志物。预防的重点主要集中在提供足够的磷和钙摄入，但仍需要更多研究。迄今为止，在孟加拉国，既没有足够关于临床风险因素的数据，也没有能检测有骨质减少风险的早产儿的有效生化标志物，也没有补充剂以及适当及时的管理方案。
