title: Determinants of Severe Metabolic Bone Disease in Very Low-Birth-Weight Infants with Severe Bronchopulmonary Dysplasia Admitted to a Tertiary Referral Center.
abstract: OBJECTIVE
  Nonrespiratory comorbidities are common among preterm infants with severe bronchopulmonary dysplasia (BPD) referred to tertiary perinatal centers. We evaluated the incidence, severity, and risk factors for metabolic bone disease (MBD) in this population.
  
  
  METHODS
  We conducted a retrospective cohort study of all infants born ≤ 1,500 g who were diagnosed with severe BPD in our single, tertiary referral center between September 2010 and October 2012. MBD severity was classified by serial radiography.
  
  
  RESULTS
  Among the 83 infants diagnosed with severe BPD, 26 (31%) developed severe MBD (rickets). Male gender and lower gestational age and birth weight were associated with increased odds of severe MBD. After adjustment for these potential confounders, cytomegalovirus infection, postnatal growth restriction, surgical necrotizing enterocolitis, and blood culture confirmed sepsis were associated with increased odds of severe MBD. The cumulative duration of therapy with furosemide, hydrocortisone, and prednisolone each correlated with significantly greater probability of severe MBD.
  
  
  CONCLUSIONS
  Severe MBD was common in this referral-based cohort with severe BPD. The high incidence in this population is likely explained by the coexistence of multiple exposures and comorbidities associated with bone demineralization.
authors: Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Erik A
authors: EA
authors: Jensen
authors: Division of Radiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Ammie M
authors: AM
authors: White
authors: Department of Pediatrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital of Southern Medical University, Shenzhen, China.
authors: Peihui
authors: P
authors: Liu
authors: Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Keolamau
authors: K
authors: Yee
authors: Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Brenda
authors: B
authors: Waber
authors: Department of Pharmacy Services, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Heather M
authors: HM
authors: Monk
authors: Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Huayan
authors: H
authors: Zhang
mesh_terms: D001724:Birth Weight; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000453:epidemiology*; D001997:Bronchopulmonary Dysplasia / Q000150:complications*; D015897:Comorbidity; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D005865:Gestational Age; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D062606:Tertiary Care Centers
chemical_list: D005665:Furosemide; D011239:Prednisolone; D006854:Hydrocortisone