ESPE Abstracts (2018) 89 P-P1-025

Intrauterine Growth Restriction, Antenatal Steroids, Gestational Age and Breast Feeding Influence Bone Health in Prepubertal Children Born Preterm

Natascia Di Iorgia, Annalisa Calcagnoa, Paola Dianaa, Sara Notarnicolaa, Anna Maria Elsa Allegria, Flavia Napolia, Giuliana Cangemib, Mariagrazia Calevoc, Luca Ramenghid & Mohamad Maghniea


aDepartment of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; bGiannina Gaslini Institute, Genova, Italy; cEpidemiology and Biostatistics Section, Scientific Directorate, Istituto Giannina Gaslini, Genova, Italy; dNeonatal Intensive Care Unit Giannina Gaslini Institute, Genova, Italy.


Objectives: To assess the long-term impact of prematurity on bone and body composition by using Dual-energy X-ray absorptiometry (DXA).

Methods: DXA scans were performed in 100 preterm (PT) (n=42F, n=58M, mean weeks’gestation 31.5±2.6; range 26−36) and 51 born at term (BT) healthy infants (n=28F, n=23M). DXA measures of total body and lumbar spine mineral density (TB/L1-L4 BMD, g/cm2 and Z-score), bone mineral content (TB-BMC, g), fat mass (FM%, kg) and free-fat mass (FFM, kg) were obtained. Height (SDS), BMI (S.D.S.) and 25-Hydroxyvitamin D, PTH, CTx, BAP were measured. Twenty-seven subjects (n=21PT, n=6BT) were born IUGR, 55 PT underwent antenatal steroids and 43 (n=20PT, n=23BT) were breastfed.

Results: Median age at study was 6.7±1.3yrs (range 5−9). There were no significant differences in anthropometrics, DXA and biochemical markers between PT and BT children. However, positive correlations were found between gestational age or birth weight and BMC, BMD, BMD Z-score both at TB and L1–L4. Steroids and breastfeeding were negatively (−0.16<r’s<−0.39; all P’s<0.04) and positively (0.18<r’s<0.29; all P’s<0.02), respectively, associated with all bone parameters. IUGR (17.9%) were shorter with significantly lower DXA BM (all P’s<0.05). In multiple regression analyses gestational age was predictive of BM (4.8%) in PT but not in BT children.

Conclusions: DXA and biochemical measurements represent a promising diagnostic tool for bone assessment in preterm children after the age of 5 years. Breastfeeding is associated with better bone health while gestational age, IUGR and antenatal steroids might represent long-lasting risk factors.