ESPE Abstracts (2022) 95 P1-29

ESPE2022 Poster Category 1 Bone, Growth Plate and Mineral Metabolism (46 abstracts)

Don’t forget the bones: incidence and risk factors of Metabolic Bone Disease in a cohort of preterm infants.

Michela Perrone 1 , Amanda Casirati 2 , Stefano Stagi 3 , Roggero Paola 1,4 & Fabio Mosca 1,4


1Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; 2Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 3Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy; 4Department of Clinical Science and Community Health, University of Milan, Milan, Italy

Background and Aim: Metabolic Bone Disease of Prematurity(MBD) is a condition of reduced bone mineral content(BMC) compared to the expected for gestational age(GA). Preterm birth interrupts the physiological process of calcium(Ca) and phosphorus(P) deposition that occurs mostly in the 3rd-trimester of pregnancy, leading to an inadequate bone mineralization during intrauterine life(IUL). After birth, an insufficient intake of Ca and P carries on this alteration, resulting in overt disease. Despite advances in neonatal intensive care, MBD is still frequent in preterm infants, with an incidence of 16-23% in Very-Low-Birth-Weight(VLBWI, BW<1500g), and 40-60% in Extremely-Low-Birth-Weight(ELBW, BW<1000g) infants. Several risk factors are associated with MBD(e.g. malabsorption, parenteral nutrition(PN), bronchodysplasia(BPD), necrotizing enterocolitis, and chronic medications). The aim of this study was to evaluate incidence of MBD in a cohort of VLBWI and the role of some risk factors.

Material and Methods: VLBWI of a GA≤32weeks were assessed between 3rd-5th weeks of life. Subjects were classified as increased risk(G1) if P≤4.5mg/dl or ALP≥900UI/l, or standard risk(G2) if P≥4.5mg/dl and ALP≤900UI/L. GA, BW, days on PN and invasive ventilation, and occurrence of BPD were evaluated. Differences between G1-G2 were evaluated using t-test for continuous variables and χ2-test for categorical variables. The statistical significance was fixed at 0.05.

Results: We enrolled 238 VLBWI(107male, 52 at increased risk(G1). Mean P(mg/dl) and ALP(UI/L)were 4.2±1.04vs6.15±0.93 in G1 and G2 respectively (P<0.001). G1-subjects have lower GA (28.53±1.99vs29.38±1.94 weeks, P<0.01) and BW(1019.87g±243.57vs 1162.23g±245.16, P<0.001). Moreover, they needed a longer PN support(25.35days±10.51 vs 20.54days±13.55, P<0.05) and invasive ventilation(7.46 days±9.27 vs 3.41days±10.05, P<0.01). G1 presented a higher incidence of BPD(36.5% vs 20.4%, P=0.026). At linear regression analysis, BW and PN resulted as independent predictor of increased risk(P=0.001, P=0.040, respectively). Preventive strategy led to a reduction in NP, LOS and invasive ventilation(930, 1674 and 744 cumulative days respectively).

Conclusions: VLBWI have an increased risk of MBD. Low BW is correlated with alteration in BMC due to an insufficient provision of Ca and P during IUL. Moreover, despite advances in neonatal nutrition and care, is still difficult to guarantee an adequate amount Ca and P in VLBWI. Further studies are needed to explore the pathophysiological mechanisms underlying MBD in order to implement preventive strategies and reduce the incidence of this complication.

Volume 95

60th Annual ESPE (ESPE 2022)

Rome, Italy
15 Sep 2022 - 17 Sep 2022

European Society for Paediatric Endocrinology 

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