title: High incidence of rickets in extremely low birth weight infants with severe parenteral nutrition-associated cholestasis and bronchopulmonary dysplasia.
abstract: Risk factors for rickets of prematurity have not been re-examined since introduction of high mineral formula, particularly in ELBW infants. We analyzed the incidence and the risk factors of rickets in extremely low birth weight (ELBW) infants. As a retrospective case-control study from 2004 to 2008, risk factors were analyzed in 24 patients with rickets versus 31 patients without. The frequency of rickets in ELBW infants was 24/55 (44%). Infants with rickets were diagnosed at 48.2 ± 16.1 days of age, and improved by 85.3 ± 25.3 days. By radiologic evaluation, 29% were grade 1 rickets, 58% grade 2 and 13% grade 3. In univariate analysis, infants with rickets had significantly higher incidence of patent ductus arteriosus, parenteral nutrition associated cholestasis (PNAC), severe PNAC and moderate/severe bronchopulmonary dysplasia (BPD). In multiple regression analysis, after adjustment for gestation and birth weight, rickets significantly correlated with severe PNAC and with moderate/severe BPD. Serum peak alkaline phosphatase levels were significantly elevated in rickets (P < 0.001). In ELBW infants, the incidence of rickets of prematurity remains high and the incidence of severe PNAC and moderate/severe BPD was significantly increased 18 and 3 times, respectively.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Soon Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Ran
authors.initials: R
authors.lastname: Namgung
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Park
authors.forename: Ho Sun
authors.initials: HS
authors.lastname: Eun
authors.forename: Kook In
authors.initials: KI
authors.lastname: Park
authors.forename: Chul
authors.initials: C
authors.lastname: Lee
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D001724:Birth Weight; D001997:Bronchopulmonary Dysplasia / Q000209:etiology*; D016022:Case-Control Studies; D002779:Cholestasis / Q000209:etiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D012279:Rickets / Q000000981:diagnostic imaging / Q000201:enzymology / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000469:Alkaline Phosphatase