Abstract
In this study, we aimed to (a) evaluate postnatal changes in bone development in relation to growth and (b) to determine factors associated with bone development, from birth to 24 months of corrected age. The metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT) were used to evaluate bone development in 98 preterm infants, during hospitalization and follow-up. The mcSOS and mcBTT values not only declined in the first 6 weeks of hospitalization but also during follow-up. The mcSOS reached its lowest point at 12 months (β=-34.64), while the mcBTT reached a plateau between 12 and 24 months (β=0.06). Univariable analysis showed that gender (p=0.28), time (p<0.001), and growth parameters (p<0.001) were significant negative associated factors with mcSOS, whereas with mcBTT, time (p=0.009), length (p=0.063), length standard deviation scores (SDS) (p=0.027), head circumference (p=0.005), and head circumference SDS (p=0.007) were significant positive. The multivariable model revealed that time (β= -3.364, p=<0.001), weight (β=-0.007, p<0.001) and length (β=1.163, p<0.001) for mcSOS and length (β=-0.021, p<0.001), and length SDS (β= 0.066, p<0.001) and head circumference (β=0.049, p<0.001) for mcBTT remained highly significant associated factors.Conclusion: The most important finding is that mcSOS decreased and the mcBTT reached a plateau to 24 months. In both mcSOS and mcBTT, the growth parameters were significant factors.Clinical Trial Registration: N/AWhat is known:• Metabolic bone disease is one of the possible long term adverse outcomes after preterm birth.• Metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT) decline in the early postnatal period.What is new:• During follow-up, mcSOS further decreased and reached its lowest point at 12 months, while the mcBTT reached a plateau up to 24 months.• Postnatal nutrition in relation to comorbidity does not meet the optimal mineralization rate of the developing preterm bone.
Highlights
Premature infants are at risk to develop metabolic bone disease (MBD), because they miss out the last phase of active bone mineralization in the womb and are born with a significantly lower mineral bone store than term infants
Our study incorporated a sample of 99 preterm infants, born between March 2009 and October 2014, who were admitted to our level 3 neonatal intensive care unit (NICU) of the Amsterdam UMC, Location VU University Medical Center (VUmc), the Netherlands
This is a substudy of a longitudinal observational study: “the Infant study”, that evaluated the immunogenetic, pharmacological, and neurodevelopmental aspects of nosocomial sepsis and meningitis in preterm infants born appropriate for gestational age (AGA) and preterm infants born too small for gestational age (SGA) [18]
Summary
Premature infants are at risk to develop metabolic bone disease (MBD), because they miss out the last phase of active bone mineralization in the womb and are born with a significantly lower mineral bone store than term infants. Studies showed that several risk factors are associated with the development of MBD, for example, treatment with loop diuretics and/or steroids affects bone mineralization [8,9,10]. Gaio et al showed that infants with BPD are more likely to develop MDB, due to lower energy intake, prolongation of the TPN period, and more days to regain birth weight, compared to infants without BPD [9]. As a consequence of severe illnesses, infants need more TPN and mechanical ventilation days, which influence bone development [3,4,5,6,7, 9, 10, 12]
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