Abstract

BackgroundPreterm infants may be more vulnerable to fractures due to various factors, including metabolic bone disease, but an increased risk of fractures up to the age of 2 is unproven.ObjectiveTo compare fracture patterns in premature and full-term children in the first 3 years of life.Materials and methodsA retrospective study was conducted. We excluded any child who returned with the same injury, with known metabolic bone disease, with any disease or condition known to reduce bone density, who received any medication known to affect Vitamin D metabolism within 3 months of enrollment or who had fractures post-surgery/resuscitation. Variables such as the number of fractures sustained each year, age of presentation to the Emergency Department and mechanism of injury were compared between the preterm and term groups using statistical analysis (χ2 and Fisher exact test for categorical variables and Student’s t-test for continuous variables). Simple linear regression was performed on the total number of fractures sustained by age 3.ResultsForty-four children with fractures were included. Of these, none were born extremely preterm, 24 (55%) were preterm, and 20 (45%) were born at term. Mean gestational ages of the preterm and term groups were 32 weeks 3 days and 39 weeks 6 days, respectively. There were no extremely low birth weight or very low birth weight children. There was no significant difference in the number of fractures sustained yearly, the age of presentation to the Emergency Department or the site of fracture between preterm and term groups. Linear regression showed that the total number of fractures sustained by age 3 years was unrelated to prematurity status, gender or birth weight category.ConclusionNo significant difference in fracture number or pattern was identified.

Highlights

  • Preterm infants may be more vulnerable to fractures due to various physiological, metabolic and environmental factors [1]

  • Given the 6% fracture prevalence that we found in our preterm group, in order to confidently reject our null hypothesis, we would have needed a total sample size of 9,537

  • The number of fractures sustained for each year of life, total number of fractures sustained by the age of 3 and site of fractures are not significantly different between the preterm and term groups

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Summary

Introduction

Preterm infants may be more vulnerable to fractures due to various physiological, metabolic and environmental factors [1]. Metabolic bone disease of prematurity can be defined as a reduction in organic protein matrix and/or a reduction in mineral component with or without rachitic changes [5]. It is estimated that metabolic bone disease affects 16–40% of extremely low birth weight and very low birth weight preterm infants delivered at less than 28 weeks of gestation [7]. Infants with metabolic bone disease have an increased early infancy fracture risk, with an estimated 10% of very low birth weight. Preterm infants may be more vulnerable to fractures due to various factors, including metabolic bone disease, but an increased risk of fractures up to the age of 2 is unproven

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