Prematüre bebeklerde seri kantitatif kemik ultrasonografi ölçümleri ile osteopeninin değerlendirilmesi

Yıl 2019, , 45 - 51, 25.02.2019

Sara Erol , Ayşegül Zenciroğlu

https://doi.org/10.18229/kocatepetip.487759

Öz

AMAÇ: Son yıllarda perinatal tıbbi uygulamaların gelişmesiyle preterm bebeklerde mortalite önemli ölçüde azalmıştır. Bu bebeklerde prematüre osteopenisini de içeren çok sayıda komplikasyon gelişebilmektedir. Bu çalışmanın amacı prematüre osteopenisinin epidemiyolojik özelliklerinin ve risk faktörlerinin belirlenmesidir.

GEREÇ VE YÖNTEM: Yenidoğan yoğun bakım ünitesine 6 aylık süreçte başvuran prematüre bebekler çalışmaya alındı. Hastaların kemik mineral yoğunluklarını belirlemek için kantitatif kemik ultrasonografiyle kemik ses hızları ve z skorları ölçüldü. Ölçümler ilk haftadan itibaren ardışık 5 hafta boyunca haftada bir kez olmak üzere tekrarlandı. Z skoru değeri <-1 olan hastalar osteopenik, ≥ -1 olanlar normal kemik mineral içeriğine sahip hastalar olarak tanımlandı. BULGULAR: 81 prematüre bebek çalışmaya alındı. Gestasyonel yaşları median 33 (24-36) hafta, doğum ağırlıkları ortalama 1834±476 gramdı. Olguların kemik ses hızı ve z skoru değerlerinin beş haftalık süre içinde istatistiksel olarak anlamlı düzeyde azaldığı görüldü (p<0.001). Kemik ses hızı ve z skoru ölçüm değerleri ile doğum sayısı, çoğul gebelik, annede hastalık varlığı ve annenin ilaç kullanımı arasında istatistiksel anlamlı ilişki bulunmadı (p>0.05). Osteopenik hastalarda doğum ağırlığının ve gestasyonel yaşın daha küçük olduğu (sırasıyla; p=0.042, p=0.015) saptandı.

SONUÇ: Uygun enteral ve parenteral beslenme rejimlerine rağmen prematürelerde ve çok düşük doğum ağırlıklı bebeklerde osteopeni gelişebilir. Ancak prematüre osteopenisi üzerine etkili diğer nedenlerin oluşturacağı riskler yeterli vitamin ve mineral desteğiyle azaltılabilir.

Anahtar Kelimeler

osteopeni, prematüre, ultrasonografi

EVALUATION OF OSTEOPENIA BY SERIAL QUANTITATIVE BONE ULTRASONOGRAPHY MEASUREMENTS IN PREMATURE INFANTS

Öz

OBJECTIVE: In recent years, mortality of preterm infants has been significantly reduced by the development of perinatal medical practices. Numerous complications may occur in these infants, including osteopenia. The aims of this study are to determine the epidemiological characteristics and risk factors of premature osteopenia.MATERIAL AND METHODS: Preterm infants who applied to neonatal intensive care unit within 6-months were enrolled in this study. The bone speed of sounds and z-scores were measured by quantitative bone ultrasonography to determine bone mineral density of the patients. The measurements were repeated once a week for 5 consecutive weeks from first week after the birth. Patients with z-score of <-1 were defined as osteopenic, while those with z-score of ≥-1 were defined as patients with normal bone mineral content.

RESULTS: A number of eighty premature infants were included in the study. Gestational ages were median 33 (24-36) weeks and the mean birth weights were 1834 ± 476 grams. The bone speed of sound and z score values significantly decreased within five weeks (p<0.001). The bone speed of sound and z score were not statistically related with the number of birth, multiple gestation, presence of maternal disease and maternal drug use (p>0.05). In osteopenic cases birth weight and gestational age were found to be smaller (p = 0.042, p= 0.015, respectively).

CONCLUSIONS: Osteopenia may develop in premature and very low birth weight infants despite appropriate enteral and parenteral feeding regimens. However, the risks that may be caused by other factors affecting prematurity osteopenia can be reduced by adequate vitamins and minerals.

Anahtar Kelimeler

Osteopenia, prematurity, ultrasonography

Kaynakça

• Referans1. Greer, FR. Calcium and Phosphorus and the Preterm Infant. NeoReviews, 2016;17(4): e195–e202.
• Referans2. Demarini S. Calcium and phosporus nutrition in preterm infants. Acta Pediatrica 2005; 94: 87-92.
• Referans3. Specker B. Nutrition influences bone development from infancy through toddler years. J Nutr. 2004;134(3): 691–5.
• Referans4. Bowden LS, Jones CJ, Ryan SW. Bone mineralisation in ex-preterm infants aged 8 years. Eur J Pediatr. 1999;158(8): 658–61.
• Referans5. Rigo J, De Curtis M, Pieltain C, et al. Bone mineral metabolism in micropremie. Clin Perinatol 2000; 27: 147.
• Referans6. Greer FR. Osteopenia of prematurıty.Annu. Rev. Nutr.1994; 14: 169-85.
• Referans7. Evans JR. Allen AC, Stinson DA, Ham¬ilton DC, Brown BS, et al. Effect of high-dose vitamin D supplementation on radiographically detectable bone dis¬ease of very low birth weight infants, J Pediatr 1989; 115: 779-86.
• Referans8. Lyon AJ, Mcintosh N, Wheeler K, Wil¬liams JE. Radiological rickets in extremely low birth weight infants. Pedi¬atr. Radiol 1987; 17: 56-8.
• Referans9. Wren TA1, Gilsanz V. Assessing bone mass in children and adolescents. Curr Osteoporos Rep. 2006 Dec;4(4):153-8.
• Referans10. Gianni M.L, Mora S, Roggero P, Mosca F. Quantitative ultrasound and dual-energy X ray absorptiometry in bone status assessment of expreterm infants Arch. Dis. Child. Fetal Neonatal Ed.2008; 93: 146-7
• Referans11. Tansug N1, Yildirim SA, Canda E, Ozalp D, Yilmaz O, Taneli F, Ersoy B. Changes in quantitative ultrasound in preterm and term infants during the first year of life. Eur J Radiol. 2011; 79(3): 428-31
• Referans12. Baroncelli GI. Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application. Pediatr Res. 2008;63(3):220-8
• Referans13. Tong L, Gopal-Kothandapani JS, Offiah AC. Feasibility of quantitative ultrasonography for the detection of metabolic bone disease in preterm infants - systematic review. Pediatr Radiol. 2018 Jun 16. doi: 10.1007/s00247-018-4161-5. [Epub ahead of print]
• Referans14. Kovacs CS. Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones. Physiol Rev. 2014; 94(4):1143-218.
• Referans15. Fewtrell MS, Loh KL, Chomtho S, Kennedy K, Hawdon J, Khakoo A. Quantitative ultrasound (QUS): a useful tool for monitoring bone health in preterm infants? Acta Pædiatrica 2008; 97(12):1625-30.
• Referans16. Tomlinson C, McDevitt H, Ahmed SF, White MP. Longitudinal changes in bone health as assessed by the speed of sound in very low birth weight preterm infants. J Pediatr 2006; 148: 450–5.
• Referans17. Ashmeade T, Pereda L, Chen M, Carver JD. Longitudinal measurements of bone status in preterm infants. Pediatr Endocrinol Metab. 2007 Mar;20(3):415-24.
• Referans18. Ritschl E, Wehmeijer K, DE Terlizzi F, Wipfler E, Cadossi R, Douma D, Urlesberger B, Müller W. Assessment of skeletal development in preterm and term infants by quantitative ultrasound. Pediatr Res. 2005;58(2):341-6.
• Referans19. McDevitt H, Tomlinson C, White MP, Ahmed SF. Quantitative ultrasound assessment of bone in preterm and term neonates. Arch Dis Child Fetal Neonatal Ed. 2005 ;90(4):F341-2.
• Referans20. Bozzetti V, Tagliabue P. Metabolic bone disease in preterm newborns: an update on nutritional issues. Ital J Pediatr 2009;35: 20
• Referans21. Backstrom MC, Kuusela AL, Maki R. Metabolic bone disease of prematurity. Ann Med 1996; 28: 275.
• Referans22. Goldfrey K, Walker-Bone K, Robinsen S, et al. Neonatal bone mass: influence of parental birth weigh, maternal smoking, body composition and activitiy during pregnancy. J Bone Miner Res 2001; 16: 1694-1703.
• Referans23. Abrams S.A. Committee on N. Calcium and vitamin d requirements of enterally fed preterm infants. Pediatrics. 2013;131(5): 676–1683.
• Referans24. Lee SYR. Prevention of Metabolic Bone Disease of Prematurity by Optimizing Calcium and Phosphate Contents in Parenteral Nutrition for Premature Infants. J Hum Nutr Food Sci 2017; 5(2): 1106.
• Referans25. Figueras-Aloy J, Álvarez-Domínguez E, Pérez-Fernández JM, Moretones-Suñol G, Vidal-Sicart S, Botet-Mussons F. Metabolic bone disease and bone mineral density in very preterm infants. J Pediatr. 2014;164:499–504