Gaio Paola, Verlato Giovanna, Daverio Marco, Cavicchiolo Maria Elena, Nardo Daniel, Pasinato Alessandra, de Terlizzi Francesca, Baraldi Eugenio
Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
Laboratory of Clinical Biophysics, IGEA, Modena, Italy.
Clin Nutr ESPEN. 2018 Feb;23:234-239. doi: 10.1016/j.clnesp.2017.09.008. Epub 2018 Feb 2.
BACKGROUND & AIMS: Preterm infants are exposed to a higher risk of developing Metabolic Bone Disease (MBD) with an increased bone fragility, a higher fracture risk and a long-term reduced linear growth and childhood height. Monitoring bone growth has become mandatory in neonatology. Several risk factors have been identified among the population of extremely low birth weight infants, but we still do not know which is the real incidence of MBD since its evaluation is not routinely performed worldwide. The aim of this study was to evaluate the incidence of MBD in preterm infants and in those suffering from bronchopulmonary dysplasia (BPD).
Prospective evaluation of patients who developed BPD (BPD group) versus infants who did not develop it (no-BPD group). We examined, in preterms <1.250 g, the metacarpus bone transmission time (mc-BTT) at birth, 21 days and 36 weeks of gestational age (GA) together with biochemical markers of bone status.
We included 135 patients, 55 with BPD. BPD patients received less total proteins in the first two weeks and less energy in the first month of life (p = 0.007 and p < 0.001 respectively). BPD patients had a worse growth velocity at two weeks of age (12.36 ± 7.86 vs 16.59 ± 7.05 g/kg/day, p = 0.001). At 21 days, BPD patients had lower phosphatemia (1.65 ± 0.031 mmol/L vs 1.85 ± 0.034 mmol/L, p = 0.007) and higher alkaline phosphatase levels (411.62 ± 135.31 IU/l vs 338.98 ± 102.20 IU/l, p = 0.005). BPD patients had significantly worse mc-BTT at 36 weeks GA (0.45 ± 0.06 vs 0.50 ± 0.08 μsec, p < 0.001) and a higher incidence of MBD (60% vs 34%; p = 0.012).
BPD infants are a special subset of patients among preterms who receive, in the first month of life, a lower energy intake than patients without BPD. BPD patients have a suboptimal bone growth and a higher incidence of MBD. Monitoring growth, bone status and optimizing nutritional intakes need to be further improved in preterm infants with BPD.
早产儿患代谢性骨病（MBD）的风险更高，其骨质脆弱性增加、骨折风险升高，且长期线性生长和儿童期身高降低。在新生儿科，监测骨骼生长已成为必需。在极低出生体重儿群体中已确定了多个风险因素，但由于全球范围内并非常规进行MBD评估，我们仍不清楚其实际发病率。本研究的目的是评估早产儿及患支气管肺发育不良（BPD）的婴儿中MBD的发病率。
对发生BPD的患者（BPD组）与未发生BPD的婴儿（非BPD组）进行前瞻性评估。我们检查了出生时、出生后21天和孕龄（GA）36周时体重<1250g的早产儿的掌骨骨传导时间（mc-BTT）以及骨状态的生化指标。
我们纳入了135例患者，其中55例患有BPD。BPD患者在出生后的前两周接受的总蛋白较少，在出生后的第一个月接受的能量较少（分别为p = 0.007和p < 0.001）。BPD患者在2周龄时的生长速度较差（12.36±7.86 vs 16.59±7.05g/kg/天，p = 0.001）。在21天时，BPD患者的血磷水平较低（1.65±0.031mmol/L vs 1.85±0.034mmol/L，p = 0.007），碱性磷酸酶水平较高（411.62±135.31IU/l vs 338.98±102.20IU/l，p = 0.005）。BPD患者在孕龄36周时的mc-BTT明显更差（0.45±0.06 vs 0.50±0.08μsec，p < 0.001），MBD的发病率更高（60% vs 34%；p = 0.012）。
BPD婴儿是早产儿中的一个特殊患者亚组，在出生后的第一个月，他们比无BPD的患者摄入的能量更低。BPD患者的骨骼生长不理想，MBD的发病率更高。对于患有BPD的早产儿，需要进一步改善生长监测、骨骼状态评估并优化营养摄入。
