Neonatology Fellow Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan Taipei city, Taipei, Taiwan (Republic of China)
Background: Very low birth weight (VLBW) preterm infants are at risk of metabolic bone disease (MBD) of prematurity despite nutritional preventive strategies. The American Academy of Pediatrics (AAP) recommends screening high-risk infants with alkaline phosphatase (ALP) or phosphate (P) started 4-5 weeks after birth and suggests a radiographic evaluation for rickets in case of markedly elevated serum ALP or clinical evidence of fractures. However, screening MBD by only biochemical markers may overlook the incidence of osteopenia and delay diagnosis. Objective: Our objective was to determine the incidence of radiologic MBD among at-risk infants through an early radiologic screening protocol and identify the risk factors. We sought to assess the effectiveness of implementing this protocol in preventing the development of severe MBD during hospitalization. Design/Methods: VLBW or preterm infants with gestational age (GA) ≤28 weeks admitted to the neonatal intensive care unit between January and December 2022 were included in this study. As per our unit’s protocol, early trophic feeding was encouraged and glycophos was used in the parenteral nutrition. All infants were screened at 5 weeks of age for radiologic MBD with a wrist X-ray, which was interpreted as normal (grade 0) or abnormal (grade 1 to 3 in order of severity) by radiologists. The incidence and risk factors for infants with early radiologic MBD were identified. Once radiologic MBD is recognized early, aggressive nutritional and medical measures are taken to prevent disease progression. Sequential radiologic and biochemical evaluations were done to monitor disease progression. The incidence of developing severe MBD during hospitalization was compared before and after the implementation of this protocol.
