title: Metabolic bone disease screening practices among U.S. neonatologists.
abstract: Preterm, low-birth-weight neonates are predisposed to metabolic bone disease (MBD). This survey aimed to assess screening, diagnostic, and treatment practices in U.S. level IIIB/IIIC neonatal intensive care units (NICUs). A 29-question anonymous online survey was e-mailed to American Academy of Pediatrics Perinatal Section members. 338 neonatologists, representing 246 IIIB/IIIC NICUs, responded. 86% reported MBD screening. Screening was primarily based on gestational age (71%), with thresholds <26 to <36 weeks. Other criteria included birth weight (64%), total parenteral nutrition duration (48%), X-ray findings (56%), diuretic use (41%), and exclusive breast-feeding (9.6%). Almost universally, diagnosis was based on elevated alkaline phosphatase, most commonly >500 U/L (58.6%). 52% used X-ray for diagnosis. Treatment included human milk fortification (83%), vitamin D (67%), calcium (65%), and phosphorus (65%) supplementation. Our survey confirms widespread awareness of MBD but highlights lack of consensus regarding definition, screening, and treatment. Further research is needed to develop and optimize strategies to prevent, recognize, and manage MBD.
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA kellya@email.chop.edu.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kelly
authors.affiliation: Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Kovatch
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA Pennsylvania Hospital, Philadelphia, PA, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Garber
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D019538:Health Care Surveys / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008297:Male; D009359:Neonatology / Q000379:methods*; D011859:Radiography; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000469:Alkaline Phosphatase
keywords: metabolic bone disease; osteopenia; prematurity; rickets; small for gestational age