title: Metabolic bone disease: a continued challenge in extremely low birth weight infants.
abstract: BACKGROUND
  Metabolic bone disease (MBD) is an important prematurity-related morbidity, but remains inadequately investigated in extremely low birth weight (ELBW) infants, the group most at risk. The objective was to describe the incidence and associated risk factors of MBD in ELBW infants.
  
  
  METHODS
  Retrospective analysis of all ELBW infants admitted between January 2005 and December 2010 who survived > 8 weeks. MBD was defined as the presence of osteopenia or rickets in radiographs.
  
  
  RESULTS
  Of the 230 infants included in the study, 71 (30.9%) developed radiological evidence of MBD (cases) of which 24/71 (33.8%) developed spontaneous fractures. MBD and fractures were noted at mean postnatal ages of 58.2 ± 28 and 100.0 ± 61 days, respectively. Compared with controls, cases were smaller at birth (664.6 ± 146 g vs 798.1 ± 129 g), more premature (25.0 ± 1.8 vs 26.4 ± 1.9 weeks), more frequently associated with mechanical ventilation, chronic lung disease, parenteral nutrition days, cholestasis, furosemide, postnatal steroids, and antibiotics use (all P < .01). Cases had lower average weekly intake of calcium, phosphorous, vitamin D, protein, and calories during the first 8 weeks of life compared with controls. Cases with MBD, compared with controls, had higher mortality (14.1 vs 4.4%) and longer hospital stay (140.2 ± 51 vs 101.0 ± 42 days; P < .01).
  
  
  CONCLUSIONS
  MBD remains an important morbidity in ELBW infants despite advances in neonatal nutrition. Further research is needed to optimize the management of chronic lung disease and early nutrition in ELBW infants.
authors: Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals, Cleveland, OH, USA.
authors: Sreekanth
authors: S
authors: Viswanathan
authors: Division of Neonatology, Department of Pediatrics, Cleveland Clinic, Cleveland, OH, USA.
authors: Wasim
authors: W
authors: Khasawneh
authors: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Kera
authors: K
authors: McNelis
authors: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Carly
authors: C
authors: Dykstra
authors: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Randi
authors: R
authors: Amstadt
authors: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Dennis M
authors: DM
authors: Super
authors: Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Sharon
authors: S
authors: Groh-Wargo
authors: Division of Critical Care, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA dkumar@metrohealth.org.
authors: Deepak
authors: D
authors: Kumar
mesh_terms: D001724:Birth Weight; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000209:etiology*; D004032:Diet; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology*; D007902:Length of Stay; D008171:Lung Diseases / Q000150:complications*; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D012279:Rickets / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors
keywords: enteral nutrition; extremely low birth weight infants; life cycle; metabolic bone disease; neonates; osteopenia; parenteral nutrition