Interventional nutritional protocol decreases osteopenia of prematurity in extremely low birth weight infants

Article type: Research Article

Authors: Mohamed, I.S.I. | Garrison, N. | Wynn, R.J. | Lakshminrusimha, S. | Ryan, R.M.^{; ;}

Affiliations: Department of Pediatrics (Neonatology), University of Montreal, Sainte-Justine Hospital, Montreal, Canada | Walgreens Home Infusion, Buffalo, NY, USA | Department of Pediatrics (Neonatology), University at Buffalo, State University of New York, Women and Children's Hospital of Buffalo, Buffalo, NY, USA | Department of Pathology and Anatomical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA | Department of Gynecology-Obstetrics, University at Buffalo, State University of New York, Women and Children's Hospital of Buffalo, Buffalo, NY, USA

Note: [] Corresponding author: Rita M. Ryan, Department of Pediatrics, Medical University of South Carolina, Children's Hospital, 135 Rutledge Avenue, Charleston, SC 29425-5610, USA. Tel.: +1 843 876; Fax: +1 843 876-1435; E-mail: ryanr@musc.edu

Abstract: Background: Osteopenia of prematurity is common among extremely low birth weight infants (ELBW). There are currently no standard practices regarding screening, prevention or treatment of this condition. Objective: To determine if introduction of a nutritional monitoring and interventional protocol would decrease the incidence and severity of osteopenia of prematurity. Methods: A nutritional protocol to monitor the needs and provide supplementation of calcium and phosphorus has been instituted in our unit. We compared ELBW infants born in the year before (Group 1) vs. after (Group 2) for lowest serum phosphorus, peak alkaline phosphatase and bone fractures. Logistic regression analysis was used to determine the independent effect of gestational age, birth weight, diuretics, postnatal steroids, and the nutritional protocol. Results: Osteopenia-related outcomes improved, including: phosphorus level <3 mg/dL (34% vs. 14%, (P = 0.003)), peak alkaline phosphatase >750 IU/L (18% vs. 7%, (P = 0.018)), and bone fractures (16.4% vs. 5.4%, (P = 0.026)). The use of diuretics increased significantly, while the use of postnatal steroids decreased significantly. Logistic regression analysis confirmed the independent contribution of our nutritional protocol as well as birth weight to osteopenia of prematurity outcomes. Conclusions: This is the first study to report that initiation of a protocol for monitoring and optimizing bone mineralization can decrease the incidence of severe osteopenia of prematurity as manifested by hypophosphatemia, elevated ALP and bone fractures. Implementation of a neonatal intensive care clinical practice guideline will improve this largely preventable medical complication.

Keywords: Osteopenia of prematurity, nutritional intervention, extremely low birth weight infants, neonatal intensive care

DOI: 10.3233/NPM-2012-50811

Journal: Journal of Neonatal-Perinatal Medicine, vol. 5, no. 1, pp. 33-40, 2012