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Published in: BMC Pediatrics 1/2021

Open Access 01-12-2021 | Patent Ductus Arteriosus | Research article

Risk factors for metabolic bone disease among preterm infants less than 32 weeks gestation with Bronchopulmonary dysplasia

Authors: Wenwen Chen, Zhenhai Zhang, Shuzhen Dai, Liping Xu

Published in: BMC Pediatrics | Issue 1/2021

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Abstract

Background

Bronchopulmonary dysplasia (BPD) infants present an increased incidence of metabolic bone disease (MBD), but it is unknown which factors contribute to this. The aim of this study was to determine the risk factors for developing MBD in BPD infants.

Methods

A retrospective review of the medical records of BPD infants admitted to the Neonatal intensive care unit at Zhangzhou Hospital between Jun 2016 and May 2020 was performed. BPD infants with MBD were identified, two contemporaneous without MBD matched by gestational age and gender were randomly selected as controls for each case of MBD. The association between putative risk factors and MBD was estimated with ORs and 95% CIs. A P-value threshold ≤0.2 was used in univariate analysis for inclusion into a multivariate (adjusted) model with a P-value of < 0.05 as statistically significant.

Results

A total of 156 BPD infants were enrolled with 52 cases of MBD and 104 controls. Fetal growth restriction (OR 6.00, 95% CI, 1.81–19.84), extremely low birth weight (OR 3.10, 95% CI, 1.07–8.94), feeding volume < 80 mL/kg/d at the end of the 4th week after birth (OR 14.98, 95% CI, 4.04–55.58), cholestasis (OR 4.44, 95% CI, 1.59–12.40), late onset sepsis (OR 3.95, 95% CI, 1.12–13.98) and prolonged (> 2 weeks) diuretics application (OR 5.45, 95% CI, 1.25–23.84) were found to be statistically significant risk factors for MBD in BPD infants.

Conclusion

In BPD infants of homogeneous gestational age, fetal growth restriction, extremely low birth weight, feeding volume < 80 mL/kg/d at the end of the 4th week after birth, cholestasis and late onset sepsis are significant risk factors for MBD. These findings provide potential predictive factors for MBD in BPD infants and warrant prospective validation.
Literature
2.
go back to reference Gaio P, Verlato G, Daverio M, Cavicchiolo ME, Nardo D, Pasinato A, de Terlizzi F, Baraldi E Incidence of metabolic bone disease in preterm infants of birth weight <1250 g and in those suffering from bronchopulmonary dysplasia. Clin Nutr ESPEN 2018; 23: 234–239. doi: https://doi.org/10.1016/j.clnesp.2017.09.008. PMID: 29460805. Gaio P, Verlato G, Daverio M, Cavicchiolo ME, Nardo D, Pasinato A, de Terlizzi F, Baraldi E Incidence of metabolic bone disease in preterm infants of birth weight <1250 g and in those suffering from bronchopulmonary dysplasia. Clin Nutr ESPEN 2018; 23: 234–239. doi: https://​doi.​org/​10.​1016/​j.​clnesp.​2017.​09.​008. PMID: 29460805.
3.
go back to reference Jensen EA, White AM, Liu P, Yee K, Waber B, Monk HM, Zhang H Determinants of severe metabolic bone disease in very low-birth-weight infants with severe Bronchopulmonary dysplasia admitted to a tertiary referral center. Am J Perinatol 2016; 33(1): 107–113. doi: https://doi.org/10.1055/s-0035-1560043. PMID: 26295968. Jensen EA, White AM, Liu P, Yee K, Waber B, Monk HM, Zhang H Determinants of severe metabolic bone disease in very low-birth-weight infants with severe Bronchopulmonary dysplasia admitted to a tertiary referral center. Am J Perinatol 2016; 33(1): 107–113. doi: https://​doi.​org/​10.​1055/​s-0035-1560043. PMID: 26295968.
4.
go back to reference Costa R, Franco C, Santos N, Maio P, Vieira F, Antunes S, et al. Metabolic bone disease of prematurity in very low birthweight infants: retrospective observational study. Acta Med Port. 2019; 32(7–8): 536–541. doi: https://doi.org/10.20344/amp.10994. PMID: 31445534. Costa R, Franco C, Santos N, Maio P, Vieira F, Antunes S, et al. Metabolic bone disease of prematurity in very low birthweight infants: retrospective observational study. Acta Med Port. 2019; 32(7–8): 536–541. doi: https://​doi.​org/​10.​20344/​amp.​10994. PMID: 31445534.
10.
12.
go back to reference Leeman L, Dresang LT, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician 2016; 93(2): 121–127. PMID: 26926408. Leeman L, Dresang LT, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician 2016; 93(2): 121–127. PMID: 26926408.
13.
go back to reference Kahveci H, Tayman C, Laloğlu F, Kavas N, Ciftel M, Yılmaz O, et al. Relationship between hemodynamically significant ductus arteriosus and ischemia-modified albumin in premature infants. Indian J Clin Biochem. 2016; 31(2): 231–236. doi: https://doi.org/10.1007/s12291-015-0523-z. PMCID: PMC4820428. Kahveci H, Tayman C, Laloğlu F, Kavas N, Ciftel M, Yılmaz O, et al. Relationship between hemodynamically significant ductus arteriosus and ischemia-modified albumin in premature infants. Indian J Clin Biochem. 2016; 31(2): 231–236. doi: https://​doi.​org/​10.​1007/​s12291-015-0523-z. PMCID: PMC4820428.
17.
go back to reference Wood CL, Wood AM, Harker C, Embleton ND. Bone mineral density and osteoporosis after preterm birth: the role of early life factors and nutrition. Int J Endocrinol. 2013; 2013: 902513. doi: https://doi.org/10.1155/2013/902513. PMID: 23662104; PMCID: PMC3639624. Wood CL, Wood AM, Harker C, Embleton ND. Bone mineral density and osteoporosis after preterm birth: the role of early life factors and nutrition. Int J Endocrinol. 2013; 2013: 902513. doi: https://​doi.​org/​10.​1155/​2013/​902513. PMID: 23662104; PMCID: PMC3639624.
19.
go back to reference Viswanathan S, Khasawneh W, McNelis K, Dykstra C, Amstadt R, Super DM, Groh-Wargo S, Kumar D Metabolic bone disease: a continued challenge in extremely low birth weight infants. JPEN J Parenter Enteral Nutr 2014; 38(8): 982–990. doi: https://doi.org/10.1177/0148607113499590. PMID: 23963689. Viswanathan S, Khasawneh W, McNelis K, Dykstra C, Amstadt R, Super DM, Groh-Wargo S, Kumar D Metabolic bone disease: a continued challenge in extremely low birth weight infants. JPEN J Parenter Enteral Nutr 2014; 38(8): 982–990. doi: https://​doi.​org/​10.​1177/​0148607113499590​. PMID: 23963689.
20.
go back to reference Lee SM, Namgung R, Park MS, Eun HS, Park KI, Lee C. High incidence of rickets in extremely low birth weight infants with severe parenteral nutrition-associated cholestasis and bronchopulmonary dysplasia. J Korean Med Sci. 2012; 27(12): 1552–1555. doi: https://doi.org/10.3346/jkms.2012.27.12.1552. PMID: 23255857; PMCID: PMC3524437. Lee SM, Namgung R, Park MS, Eun HS, Park KI, Lee C. High incidence of rickets in extremely low birth weight infants with severe parenteral nutrition-associated cholestasis and bronchopulmonary dysplasia. J Korean Med Sci. 2012; 27(12): 1552–1555. doi: https://​doi.​org/​10.​3346/​jkms.​2012.​27.​12.​1552. PMID: 23255857; PMCID: PMC3524437.
24.
go back to reference Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh. W, Bauer CR, Korones SB, Shankaran S, Laptook AR, Stevenson DK, Papile LA, Poole WK Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatrics. 2002; 110(2 Pt 1): 285–291. doi: https://doi.org/10.1542/peds.110.2.285. PMID: 12165580. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh. W, Bauer CR, Korones SB, Shankaran S, Laptook AR, Stevenson DK, Papile LA, Poole WK Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatrics. 2002; 110(2 Pt 1): 285–291. doi: https://​doi.​org/​10.​1542/​peds.​110.​2.​285. PMID: 12165580.
26.
go back to reference Dusad A, Thiele GM, Klassen LW, Gleason AM, Bauer C, Mikuls TR, et al. Organic dust, lipopolysaccharide, and peptidoglycan inhalant exposures result in bone loss/disease. Am J Respir Cell Mol Biol. 2013; 49(5): 829–836. doi: https://doi.org/10.1165/rcmb.2013-0178OC. PMID: 23782057; PMCID: PMC3931104. Dusad A, Thiele GM, Klassen LW, Gleason AM, Bauer C, Mikuls TR, et al. Organic dust, lipopolysaccharide, and peptidoglycan inhalant exposures result in bone loss/disease. Am J Respir Cell Mol Biol. 2013; 49(5): 829–836. doi: https://​doi.​org/​10.​1165/​rcmb.​2013-0178OC. PMID: 23782057; PMCID: PMC3931104.
27.
go back to reference Aceti A, Maggio L, Beghetti I, Gori D, Barone G, Callegari ML, et al. Probiotics prevent late-onset sepsis in human milk-fed, very low birth weight preterm infants: systematic review and meta-analysis. Nutrients. 2017; 9(8): 904. doi: https://doi.org/10.3390/nu9080904. PMID: 28829405; PMCID: PMC5579697. Aceti A, Maggio L, Beghetti I, Gori D, Barone G, Callegari ML, et al. Probiotics prevent late-onset sepsis in human milk-fed, very low birth weight preterm infants: systematic review and meta-analysis. Nutrients. 2017; 9(8): 904. doi: https://​doi.​org/​10.​3390/​nu9080904. PMID: 28829405; PMCID: PMC5579697.
28.
30.
go back to reference Rejnmark L, Vestergaard P, Heickendorff L, Andreasen F, Mosekilde L. Loop diuretics increase bone turnover and decrease BMD in osteopenic postmenopausal women: results from a randomized controlled study with bumetanide. J Bone Miner Res 2006; 21(1): 163–170. doi: https://doi.org/10.1359/JBMR.051003. PMID: 16355285. Rejnmark L, Vestergaard P, Heickendorff L, Andreasen F, Mosekilde L. Loop diuretics increase bone turnover and decrease BMD in osteopenic postmenopausal women: results from a randomized controlled study with bumetanide. J Bone Miner Res 2006; 21(1): 163–170. doi: https://​doi.​org/​10.​1359/​JBMR.​051003. PMID: 16355285.
Metadata
Title
Risk factors for metabolic bone disease among preterm infants less than 32 weeks gestation with Bronchopulmonary dysplasia
Authors
Wenwen Chen
Zhenhai Zhang
Shuzhen Dai
Liping Xu
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-021-02705-0

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