Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Pediatric Radiology
Published in: Pediatric Radiology 1/2021

Open Access 01-01-2021 | Child Abuse | Original Article

Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life

Authors: Liting Tong, Sarita Pooranawattanakul, Jaya Sujatha Gopal-Kothandapani, Amaka C. Offiah

Published in: Pediatric Radiology | Issue 1/2021

Login to get access

Abstract

Background

Preterm infants may be more vulnerable to fractures due to various factors, including metabolic bone disease, but an increased risk of fractures up to the age of 2 is unproven.

Objective

To compare fracture patterns in premature and full-term children in the first 3 years of life.

Materials and methods

A retrospective study was conducted. We excluded any child who returned with the same injury, with known metabolic bone disease, with any disease or condition known to reduce bone density, who received any medication known to affect Vitamin D metabolism within 3 months of enrollment or who had fractures post-surgery/resuscitation. Variables such as the number of fractures sustained each year, age of presentation to the Emergency Department and mechanism of injury were compared between the preterm and term groups using statistical analysis (χ2 and Fisher exact test for categorical variables and Student’s t-test for continuous variables). Simple linear regression was performed on the total number of fractures sustained by age 3.

Results

Forty-four children with fractures were included. Of these, none were born extremely preterm, 24 (55%) were preterm, and 20 (45%) were born at term. Mean gestational ages of the preterm and term groups were 32 weeks 3 days and 39 weeks 6 days, respectively. There were no extremely low birth weight or very low birth weight children. There was no significant difference in the number of fractures sustained yearly, the age of presentation to the Emergency Department or the site of fracture between preterm and term groups. Linear regression showed that the total number of fractures sustained by age 3 years was unrelated to prematurity status, gender or birth weight category.

Conclusion

No significant difference in fracture number or pattern was identified.
Literature
1.
Rigo J, Pieltain C, Salle B, Senterre J (2007) Enteral calcium, phosphate and vitamin D requirements and bone mineralization in preterm infants. Acta Paediatr 96:969–974CrossRef
2.
Cooper C, Westlake S, Harvey N et al (2006) Review: developmental origins of osteoporotic fracture. Osteoporos Int 17:337–347CrossRef
3.
Hovi P, Andersson S, Jarvenpaal A-L (2009) Decreased bone mineral density in adults born with very low birth weight: a cohort study. PLoS Med 6:e1000135CrossRef
4.
Bowden LS, Jones CJ, Ryan SW (1999) Bone mineralisation in ex-preterm infants aged 8 years. Eur J Pediatr 158:658–661CrossRef
5.
Viswanathan S, Khasawneh W, McNelis K et al (2014) Metabolic bone disease: a continued challenge in extremely low birthweight infants. JPEN J Parenter Enteral Nutr 38:982–990CrossRef
6.
Faienza MF, D’Amato E, Natale MP et al (2019) Metabolic bone disease of prematurity: diagnosis and management. Front Pediatr 7:143CrossRef
7.
8.
Dabezies EJ, Warren PD (1997) Fractures in very low birth weight infants with rickets. Clin Orthop Relat Res 335:233–239CrossRef
9.
Bishop NJ, Dahlenburg SL, Fewtrell MS et al (1996) Early diet of preterm infants and bone mineralization at age five years. Acta Paediatr 85:230–236CrossRef
10.
Wagner K, Wagner S, Susi A et al (2019) Prematurity does not increase early childhood fracture risk. J Pediatr 207:148–153CrossRef
11.
Horsman A, Ryan SW, Congdon PJ et al (1989) Bone mineral content and body size 65 to 100 weeks’ postconception in preterm and full term infants. Arch Dis Child 64:1579–1586CrossRef
12.
Amir J, Katz K, Grunebaum M et al (1988) Fractures in premature infants. J Pediatr Orthop 8:41–44CrossRef
13.
Dahlenburg SL, Bishop NJ, Lucas A (1989) Are preterm infants at risk for subsequent fractures? Arch Dis Child 64:1384–1385CrossRef
14.
Rogvi RA, Forman JL, Greisen G (2015) Prematurity, smallness-for-gestational age and later hospital admissions: a nation-wide registry study. Early Hum Dev 91:299–306CrossRef
15.
Jenny C, Committee on Child Abuse and Neglect (2006) Evaluating infants and young children with multiple fractures. Pediatrics 118:1299–1303
16.
Martrille L, Cattaneo C, Dorandeu A, Baccino E (2006) A multicentre and prospective study of suspected cases of child physical abuse. Int J Legal Med 120:73–78CrossRef
17.
Jones IE, Williams SM, Goulding A (2004) Associations of birth weight and length, childhood size, and smoking with bone fractures during growth: evidence from a birth cohort study. Am J Epidemiol 159:343–350CrossRef
18.
Topor LS, Borus JS, Aspinwall S et al (2016) Fractures among inpatients in a pediatric hospital. Hosp Pediatr 6:143–150CrossRef
19.
Koo WW, Sherman R, Succop P et al (1989) Fractures and rickets in very low birth weight infants: conservative management and outcome. J Pediatr Orthop 9:326–330CrossRef
20.
Moyer-Mileur L, Luetkemeier M, Boomer L, Chan GM (1995) Effect of physical activity on bone mineralization in premature infants. J Pediatr 127:620–625CrossRef
21.
Carroll DM, Doria AS, Paul BS (2007) Clinical-radiological features of fractures in premature infants- a review. J Perinat Med 35:366–375CrossRef
22.
Rubinacci A, Sirtori P, Moro G et al (1993) Is there an impact of birth weight and early life nutrition on bone mineral content in preterm born infants and children? Acta Paediatr 82:711–713CrossRef
23.
Bishop N, Sprigg A, Dalton A (2007) Unexplained fractures in infancy: looking for fragile bones. Arch Dis Child 92:251–256CrossRef
24.
Tong L, Gopal-Kothandapani JS, Offiah AC (2018) Feasibility of quantitative ultrasonography for the detection of metabolic bone disease in preterm infants — systematic review. Pediatr Radiol 48:1537–1549CrossRef
25.
Barsness KA, Cha E-S, Bensard DD et al (2003) The positive predictive value of rib fractures as an indicator of non-accidental trauma in children. J Trauma 54:1107–1110CrossRef
26.
Bulloch B, Schubert CJ, Brophy PD et al (2000) Cause and clinical characteristics of rib fractures in infants. Pediatrics 105:e48CrossRef
27.
Wei C, Stevens J, Harrison S et al (2012) Fractures in a tertiary neonatal intensive care unit in Wales. Acta Paediatr 101:587–590CrossRef
28.
Lucas-Herald A, Butler S, Mactier H et al (2012) Prevalence and characteristics of rib fractures in ex-preterm infants. Pediatrics 130:1116–1119CrossRef
29.
Smurthwaite D, Wright NB, Russell S et al (2009) How common are rib fractures in extremely low birth weight infants? Arch Dis Child Fetal Neonatal Ed 94:F138–F139CrossRef
30.
Holloway KL, Brennan SL, Kotowicz MA et al (2015) Age- and sex-related patterns of first fracture and fracture prevalence. Calcif Tissue Int 96:38–44CrossRef
Metadata
Title
Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life
Authors
Liting Tong
Sarita Pooranawattanakul
Jaya Sujatha Gopal-Kothandapani
Amaka C. Offiah
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 1/2021
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-020-04817-8

Other articles of this Issue 1/2021

Pediatric Radiology 1/2021 Go to the issue

Original Article

Performance of simultaneous multi-slice accelerated diffusion-weighted imaging for assessing focal renal lesions in pediatric patients with tuberous sclerosis complex

Original Article

Hepatic magnetic resonance T1-mapping and extracellular volume fraction compared to shear-wave elastography in pediatric Fontan-associated liver disease

Pictorial Essay

Atypical pulmonary metastases in children: pictorial review of imaging patterns

Original Article

Three-dimensional magnetic resonance imaging ultrashort echo-time cones for assessing lung density in pediatric patients

Review

Whole-body magnetic resonance imaging in children – how and why? A systematic review

Commentary

Cultural competence in pediatric radiology: Hispanic culture