Faienza Maria Felicia, D'Amato Elena, Natale Maria Pia, Grano Maria, Chiarito Mariangela, Brunetti Giacomina, D'Amato Gabriele
Pediatric Section, Department of Biomedicine and Human Oncology, University of Bari A. Moro, Bari, Italy.
Department of Electric and Electronic Engineering, City University of London, London, United Kingdom.
Front Pediatr. 2019 Apr 12;7:143. doi: 10.3389/fped.2019.00143. eCollection 2019.
Metabolic Bone Disease (MBD) of prematurity is a multifactorial disorder commonly observed in very low birth weight (VLBW, <1,500 g) newborns, with a greater incidence in those extremely low birth weight (ELBW, <1,000 g). MBD is characterized by biochemical and radiological findings related to bone demineralization. Several antenatal and postnatal risk factors have been associated to MBD of prematurity, although the main pathogenetic mechanism is represented by the reduced placental transfer of calcium and phosphate related to preterm birth. The diagnosis of MBD of prematurity requires the assessment of several biochemical markers, radiological, and ultrasonographic findings. However, the best approach is the prevention of the symptomatic disease, based on the screening of subjects exposed to the risks of developing MBD. Regarding the subjects who need to be screened, there is a substantial agreement on the potential risk factors for MBD. On the contrary, different recommendations exist on the diagnosis, management and treatment of this disorder of bone metabolism. This review was aimed at: (1) identifying the subjects at risk for MBD of prematurity; (2) indicating the biochemical findings to take in consideration for the prevention of MBD of prematurity; (3) suggesting practical recommendations on nutritional intake and supplementation in these subjects. We searched for papers which report the current recommendations for biochemical assessment of MBD of prematurity and for its prevention and treatment. The majority of the authors suggest that MBD of prematurity is a disease which tends to normalize overtime, thus it is not mandatory to mimic the rate of mineral fetal accretion through parenteral or enteral supplementation. The optimization of total parenteral nutrition (TPN) and the early achievement of a full enteral feeding are important goals for the prevention and management of MBD of prematurity.
早产代谢性骨病（MBD）是一种多因素疾病，常见于极低出生体重（VLBW，<1500g）的新生儿，在那些出生体重极低（ELBW，<1000g）的新生儿中发病率更高。MBD的特征是与骨质脱矿有关的生化和放射学表现。尽管主要发病机制是与早产相关的钙和磷的胎盘转运减少，但已有多种产前和产后危险因素与早产MBD相关。早产MBD的诊断需要评估多种生化指标、放射学和超声检查结果。然而，最佳方法是基于对有发生MBD风险的受试者进行筛查来预防症状性疾病。关于需要筛查的受试者，对于MBD的潜在危险因素有很大的共识。相反，对于这种骨代谢紊乱的诊断、管理和治疗存在不同的建议。本综述旨在：（1）确定早产MBD的高危受试者；（2）指出预防早产MBD时应考虑的生化指标；（3）对这些受试者的营养摄入和补充提出实用建议。我们检索了报告早产MBD生化评估及其预防和治疗的当前建议的论文。大多数作者认为早产MBD是一种随时间推移趋于正常化的疾病，因此不必通过肠外或肠内补充来模拟胎儿矿物质积累的速度。优化全胃肠外营养（TPN）并尽早实现完全肠内喂养是预防和管理早产MBD的重要目标。
