Division of Neonatology.
Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Curr Opin Pediatr. 2021 Dec 1;33(6):676-683. doi: 10.1097/MOP.0000000000001060.
Metabolic bone disease of prematurity, commonly referred to as osteopenia of prematurity, remains prevalent in the neonatal intensive care unit (NICU) despite recent medical advances. It is estimated that up to 60% of extreme low birth weight and 20% of very low-birth-weight infants have metabolic bone disease of prematurity. Often silent, it typically presents with poor growth, increased ventilator dependency and fractures. Clinical sequalae, such as short stature can extend into young adulthood. There is no universal consensus by neonatal intensive care unit clinicians on the screening, diagnosis, or treatment for metabolic bone disease of prematurity. The disease is often diagnosed late by radiographs or incidentally in this highly fragile population.
Suggest screening using DEXA (dual-energy X-ray absorptiometry) scans or ultrasound, in combination with serum markers like alkaline phosphatase, phosphorous levels, parathyroid hormone, and tubular reabsorption of phosphate, might identify at-risk babies earlier. The use of protocol-based screenings may aid in early diagnosis.
We present a review of the risk factors, recent screening methods, diagnosis and management of this prevalent, clinically relevant diagnosis, as well as propose a protocol for the early screening and management of this silent disease.
尽管近年来医学取得了进步，但早产儿代谢性骨病（通常称为早产儿骨质疏松症）在新生儿重症监护病房（NICU）仍很常见。据估计，多达 60%的极低出生体重儿和 20%的超低出生体重儿患有早产儿代谢性骨病。该病通常没有明显症状，其特征通常为生长不良、呼吸机依赖增加和骨折。临床后遗症，如身材矮小，可能会持续到成年早期。NICU 临床医生对早产儿代谢性骨病的筛查、诊断或治疗尚未达成普遍共识。该病通常通过 X 光片或在这个高度脆弱的人群中偶然诊断，诊断较晚。
建议使用双能 X 线吸收法（DEXA）扫描或超声结合碱性磷酸酶、磷水平、甲状旁腺激素和磷酸盐肾小管重吸收等血清标志物进行筛查，可能会更早地识别出高危婴儿。基于方案的筛查可能有助于早期诊断。
我们回顾了这种普遍存在且具有临床意义的疾病的危险因素、最近的筛查方法、诊断和治疗方法，并提出了早期筛查和管理这种无声疾病的方案。
