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Slovenska pediatrija 2021; 28: 147-153

https://doi.org/10.38031/slovpediatr-2021-3-04en

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Review article

METABOLIC BONE DISEASE OF PREMATURITY

Nina Majoranc
Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Aneta Soltirovska Šalamon
Klinični oddelek za neonatologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Abstract

Metabolic bone disease (MBD) in the newborn − osteopenia, is a disease that occurs mainly as a result of inadequate bone mineralisation, and its development is also influenced by genetic, mechanical and environmental factors. After birth, the transfer of minerals from the mother through the placenta ceases, so the newborn is completely dependent on enteral or parenteral intake to meet his/her needs. On the other hand, the physiological adaptation of bone to extrauterine life leads to an increase in bone resorption − physiological osteopenia. Catch-up mineralisation in premature infants is achieved by the end of the first year of life, although the question of the long-term consequences for achieving maximum bone mass in this group of children remains open. The best approach to reducing the incidence of MBD is prevention based on screening newborns at risk for MBD. Early optimal parenteral and enteral nutrition, adequate supply of vitamin D, and removal of risk factors are key to preventing the development of neonatal osteopenia. Biochemical screening tests: serum phosphorus levels, alkaline phosphatase in combination with the values of excreted minerals in the urine are useful indicators of bone metabolism. Dual-energy X-ray absorptiometry and quantitative ultrasound are complementary methods for measuring bone mineral density in newborns. This article discusses the clinical features and pathophysiology of MBD, the diagnostic process and practical treatment recommendations.

Key words: metabolic bone disease, osteopenia, preterm newborn