Abstract
BackgroundBronchopulmonary dysplasia (BPD) infants present an increased incidence of metabolic bone disease (MBD), but it is unknown which factors contribute to this. The aim of this study was to determine the risk factors for developing MBD in BPD infants.MethodsA retrospective review of the medical records of BPD infants admitted to the Neonatal intensive care unit at Zhangzhou Hospital between Jun 2016 and May 2020 was performed. BPD infants with MBD were identified, two contemporaneous without MBD matched by gestational age and gender were randomly selected as controls for each case of MBD. The association between putative risk factors and MBD was estimated with ORs and 95% CIs. A P-value threshold ≤0.2 was used in univariate analysis for inclusion into a multivariate (adjusted) model with a P-value of < 0.05 as statistically significant.ResultsA total of 156 BPD infants were enrolled with 52 cases of MBD and 104 controls. Fetal growth restriction (OR 6.00, 95% CI, 1.81–19.84), extremely low birth weight (OR 3.10, 95% CI, 1.07–8.94), feeding volume < 80 mL/kg/d at the end of the 4th week after birth (OR 14.98, 95% CI, 4.04–55.58), cholestasis (OR 4.44, 95% CI, 1.59–12.40), late onset sepsis (OR 3.95, 95% CI, 1.12–13.98) and prolonged (> 2 weeks) diuretics application (OR 5.45, 95% CI, 1.25–23.84) were found to be statistically significant risk factors for MBD in BPD infants.ConclusionIn BPD infants of homogeneous gestational age, fetal growth restriction, extremely low birth weight, feeding volume < 80 mL/kg/d at the end of the 4th week after birth, cholestasis and late onset sepsis are significant risk factors for MBD. These findings provide potential predictive factors for MBD in BPD infants and warrant prospective validation.
Highlights
Bronchopulmonary dysplasia (BPD) infants present an increased incidence of metabolic bone disease (MBD), but it is unknown which factors contribute to this
Study population and setting The study was conducted in Zhangzhou Hospital with retrospective review of the electronic medical recordderived data of BPD infants who admitted to the Neonatal intensive care unit (NICU) between Jun 2016 and May 2020
At the time of assessment, infants with no oxygen requirement were classified as having mild BPD, infants requiring < 30% oxygen were classified as having moderate BPD and infants with a need for positive pressure ventilation/continuous positive pressure and/or oxygen requirement ≥30% were classified as having severe BPD [8], and (4) diagnosis of MBD that defined as peak serum alkaline phosphatase (ALP) higher than 900 U/L and serum phosphorus ower than 1.8 mmol/L, which yielded a sensitivity of 100% at a specificity of 70%, with or without radiographic changes of long bones [9]
Summary
Bronchopulmonary dysplasia (BPD) infants present an increased incidence of metabolic bone disease (MBD), but it is unknown which factors contribute to this. The aim of this study was to determine the risk factors for developing MBD in BPD infants. Chen W et al found that lower gestational age (< 30 weeks), vitamin D supplementation at > 14 days of age, and achievement of total enteral nutrition (TEN) beyond 28 days of age were independent risk factors for MBD in infants < 34 weeks gestational age [5]. Some risk factors for MBD might become not obvious in infants with BPD since demographic and complications could be more homogeneous
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