Metabolic Bone Disease of Infancy in the offspring of mothers with bariatric surgery: A series of 5 infants in contested cases of child abuse.

Abstract

Metabolic Bone Disease of Infancy is a multifactorial disorder of bone fragility in infants who typically present under 6 months of age with multiple unexplained fractures. Major risk factors for this disorder relate to the fetal time period and include decreased provision of the essential nutrients for bone formation during pregnancy (calcium, phosphate, vitamin D, and protein), prematurity, and decreased fetal bone loading. This study presents 5 infants with multiple unexplained fractures born to women who had prior bariatric surgery in which child abuse was alleged, and the alleged perpetrator denied wrong doing. The radiographic findings showed poor bone mineralization and were consistent with Metabolic Bone Disease of Infancy. Using the Utah Paradigm to understand risk factors for MBDI, the authors believe the nutritional deficiencies that accompany bariatric surgery likely contribute to the bone fragility in these 5 infants. Other risk factors for MBDI were appreciated in 4 of the 5 cases. 1,25 dihydroxyvitamin D was elevated or high-normal suggesting calcium deficiency in 2 cases. We believe infants born to mothers who have had prior bariatric surgery are at increased risk for bone fragility and MBDI during the first 6 months of life.