The frequency of osteopenia in premature babies and the ethiological risk faktors Original Article

Year 2009, Volume: 44 Issue: 1, 18 - 22, 01.03.2009

Esin Yıldız Gök Sultan Kavuncuoğlu Bilge Şahin Akkelle Betül Karaatmaca Sibel Özbek

Abstract

Aim: Osteopenia is an important morbidity of very low birth weight nbsp; infants In this study we aimed to appreciate the frequancy of osteopenia the ethiological factors and the clinical and laboratory findings of osteopenia in our clinic nbsp; Material and Method: The records of preterm infants who were admitted from January 2004 to December 2006 with the diagnosis of osteopenia were reviewed Clinical data and information about these infants were assessed according to the data base of our clinic and the files of cases The gestational age sexuality birth weight clinical findings and laboratory findings of our cases were recorded This was a retrospective medical chart review Results: Out of a total of 3691 cases 113 were diagnosed as osteopenia The incidence was 3 1 94 cases 83 were pretems with lt;32 gestational age and 91 of them had lt;1250 gr birth weights Respiratory dystress 39 mild and nbsp; 47 severe was the most common initial complaint of these preterm infants and among these cases 73 had been supported by ventilation 42 cases received steroid treatment because of bronchopulmonary dysplasia 50 of the cases were diagnosed at the age of 15 30 days postnatally The cases who were symptomatic comprised 50 of the total number and thorax deformities were the major manifestations Also in 4 cases femurfracture was identified As the evidence of bone undermineralisation increased ALP and decreased P levels were the mostly determined laboratory findings nbsp; Conclusions: The incidence of osteopenia of prematurity in our clinic was determined as 3 1 nbsp; wich was lower than that reported in the literature The incidences of osteopenia among nbsp; infants born before 32 week of gestational age and with lt;1000 gr birth weight were respectively 22 5 nbsp; and 18 4 The pathogenesis of disease is multifactorial Respiratory dystress syndrome nbsp; ventilation support steroid treatment for bronchopulmonary dysplasia sepsis necrotizing enterocolitis total parenteral nutrition prolonged hospitalization were confirmed as common ethiological factors Turk Arch Ped 2009; 44: 18 22 Key words: Bronchopulmonary dysplasia BPD respiratory dystress syndrome RDS steroid treatment very low birth weight preterm

Keywords

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Erken doğmuş bebeklerde osteopeni sıklığı ve etiolojik risk etmenlerinin geriye dönük olarak değerlendirilmesi Orijinal Araştırma

Abstract

Amaç: Çok düşük doğum ağırlıklı erken doğmuş bebeklerde önemli bir sorun olan osteopeninin birimimizdeki sıklığını etiolojide rol oynayan risk etmenlerini klinik ve laboratuvar bulgularını değerlendirmektir Gereç ve Yöntem: Ocak 2004 Aralık 2006 tarihleri arasında birimimizde izlenen erken doğmuş bebeklere ait bilgiler veri tabanı ve hasta dosyalarından elde edildi Olgularımızın cinsiyet gebelik haftası GH doğum ağırlığı DA klinik bulgular etiolojide rol oynayan risk etmenleri ve laboratuvar bulguları değerlendirildi Çalışma geriye dönük ve kesitseldi Bulgular: Üç yıl içinde 3691 nbsp; erken doğmuş bebek izlendi 113 olgu osteopeni tanısı aldı Genel sıklık 3 1 idi 94 83 erken doğmuş bebek 32 hafta altında 91 80 olgu 1250 gramdan küçüktü Osteopenili erken doğmuş bebeklerin 47’si ağır respiratuvar distres sendromu RDS 39’u hafif RDS olup 73 olguya vantilatör desteği verildi Kırkiki osteopenik erken doğmuş bebek bronkopulmoner displazi BPD tanısıyla steroid tedavisi aldı Osteopeni tanı yaşı 50 olguda 15 30 gün idi Klinik olarak erken doğmuş bebeklerin yarısı bulgu vermezken bulgusu olan olgularda Rozary Harrison oluğu göğüs kafesi şekil bozuklukları görüldü Dört olguda femur kırığı saptandı Laboratuvar bulgularında alkalen fosfataz ALP yüksekliği ve hipofosfatemi ön plandaydı nbsp; nbsp; Çıkarımlar: Birimimizin osteopeni sıklığı literatürden düşük idi Genel sıklık 3 1 32 GH’den küçüklerde 22 5 1000 gram altında 18 4 bulundu Osteopeni gelişmesinde RDS nbsp; vantilatör tedavisi BPD nedeniyle steroid tedavisi yanında sepsis nekrotizan enterokolit NEK total parenteral beslenme TPB hastanede uzun süreli yatış önemli nbsp; etiolojik etmenlerdi Türk Ped Arş 2009; 44: 18 22 Anahtar kelimeler: Çok düşük doğum ağırlıklı erken doğmuş bebek bronkopulmoner displazi BPD osteopeni respiratuar distres sendromu RDS steroid tedavisi

Keywords

Çok düşük doğum ağırlıklı erken doğmuş bebek, bronkopulmoner displazi (BPD), osteopeni, respiratuar distres sendromu (RDS), steroid tedavisi

References

• İnce Z. Pretermlerin fizik özellikleri. İçinde: Neyzi O, Ertuğrul T (ya- zarlar) Pediatri Cilt 2. 3. baskı. İstanbul: Nobel Tıp Kitabevi, 2002:326-7.
• Kızılateş Ünal S. Preterm osteopenisi. Ankara Ünv.Tıp Fakültesi Mecmuası 2002; 55: 217-22.
• Berseth CL, Abrams SA. Osteopenia of prematurity. In: Taeusch HW, Ballard (eds). Avery’s Diseases of the Newborn. Seventh edition. Philadelphia: WB Saunders, 1998:970-5.
• Backström MC, Kouri T, Kuusela AL, Sievänen H, Koivisto AM, Ikonen RS, Mäki M. Bone isoenzyme of serum alkaline phospha- tase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr. 2000; 89: 867-73.
• Ballard JL, Khoury JC, Wedig K, et al. New Ballard Score, ex- panded to include extremely prematüre infants. J Pediatr 1991; 119: 417-23.
• Özek Eren. Prematürelerde osteopeni ve rikets. Neonatoloji: Murat Yurdakök, Gülşen Erdem (yazarlar). Ankara; 2004: 303-7.
• Mc Intosh N. Calcium and phosphorus metabolism and bone mi- neral content. In: Levitt G, Harvey D, Cooke R (eds). Practical Perinatal Car. Oxford: Butterworth-Heinemann, 1999: 137-43.
• Brooke OG, Lucas A. Metabolic bone disease in preterm infants. Arch Dis Child 1985; 60: 682-5.
• Rigo J, Curtis M, Pieltain C, Picaud JC, Salle BL, SenterreJ. Bo- ne mineral metabolism in the micropremie. Clin Perinatol 2000; 27: 147-70.
• CM Harrison, K Johnson, E McKechnie. Osteopenia of prematu- rity: a national survey and review of practice. Acta Paediatr 2008; 97: 407.
• Schanler RJ, Garza C, Smith EO. Fortified mothers’milk for very low birth weight infants: Results of macromineral balance studi- es. J Pediatr 1985;107: 767-74.
• Kalhan S, Sakrer F. Metabolic and endocrine disorders. In: Fa- naroff AA, Martin RJ (eds). Neonatal-Perinatal Medicine. ST Lou- is: Mosby, 1999:1439-563.
• Koo WWK, Tsang RC. Calcium and magnesium homeostais. In: Avery GB, Fletcer MA, Donald MG (eds). Neonatology: Patoph- ysiology and Management of the Newborn. Philadelphia: Lippin- cott-Williams and Wilkins,1999:715-37.
• Kovar I, Mayne P, Barltop D. Plasma alkaline phosphatase acti- vity: A screening test for rickets in preterm neonates. Lancet 1982; 6: 308-10.
• Rusk C. Rickets screening in preterm infant. Neonatal Network 1998; 17: 55-7.
• Bishop N. Bone disease in preterm infants. Arch Dis Child 1989; 64: 1403-9.
• Altuncu E, Akman İ, Yurdakul Z. Quantitive ultrasound and bioc- hemical parameters for the assessment of osteopenia in preterm infants. J Matern Fetal Neonatal Med 2007; 20: 401-5.
• Rauch F, Schoenau E. Skeletal development in prematüre in- fants: a review of bone physiology beyond nutritional aspects. Arch Dis Child Fetal Neonatal Ed 2002; 86; 82-6.