Risk Factors In Metabolic Bone Disease Of Premature Infants

Objective To explore the high risk factors of Metabolic bone disease(MBD)in premature infants and clinical data were retrospectively analyzed so as to provide evidence for optimal clinical management.Method Premature infants(BW<1500g)admited in The Affiliated Hospital of Qingdao University from 2016-January to 2017-December were choosed in this study.Patient with ALP > 500IU/L and blood phosphorus < 1.5 mmol/L were selected as MBD group.NonMBD group were randomly selected from the premature infants with birth weight < 1500 g and the ratio was 1:2.Data of basic characteristics,drug,enteral / parenteral nutrition and biochemical indicators of bone metabolism were statistical anayzed in two groups.Results A total of 440 premature infants with birth weight <1500g were admitted to the hospital during the study period.There were 58(13.2%(58/440))cases in the MBD group,among them patients of BW < 1000 g account for 56.9%(33/58).1.Basic information: ?Gestational age(GA)and BW in MBD group were significantly lower than those in non-MBD group(GA 29.13±1.87/29.87±2.15w),(BW1044.10±202.13/1197.77±209.04 g),(P < 0.05).?The proportion of small for gestational age(SGA)in MBD group was significantly higher than that in non-MBD group(27.6%/12.9%),(P < 0.05).?There was significant difference in pulmonary surfactant(PS)used between the two groups(MBD /non MBD 48.3%/30.2%,P < 0.05).?There were no significantly differences in sex,mode of delivery,maternal diseases during pregnancy,asphyxia,number of pregnancies and placental function between the two groups(P > 0.05).2.Drugs: Consumption of caffeine,diuretic and steroid in MBD group were significantly higher than those in non-MBD group(caffeine 84.5%/65.5%),(diuretic43.1%/16.4%),(steroid 13.8%/0.9%),(P <0.05).3.Complications: Significant high incidence of bronchopulmonary dysplasia(BPD),neonatal necrotizing enterocolitis(NEC)and sepsis were found in MBD group(P < 0.01).? The duration of CPAP and hospital stay in MBD group were significantly longer than those in MBD group(CPAP24.72±20.15/11.43±13.65d),(hospital stay71.31±18.61/53.96±15.90 d),(P =0.000).4.Nutrition fators: The duration of breast-feeding in MBD group was longer than that in non-MBD group(35.28±28.026/11.85±20.155 d),the initial time of enteral nurtrition(EN) and duration of parenteral nurtrition was longed than that in non-MBD group(initial time of EN 1.93±0.876/1.36±0.727 d),(PN 34.97±14.82/18.07±6.93d),the differences were statistically significant(P =0.000).There was no significant difference in calcium and phosphorus supplement and breast milk fortifier between the two groups.5.Biochemical indicators of bone metabolism :Serum level of ALP,phosphorus(P),magnesium(Mg),vitamin D3(Vit D3)were significantly higher in MBD group(P =0.000),(ALP786.09±243.03/338.03±90.69U/L),(P1.22±0.41/2.01±0.32mmol/L),(Mg 0.96±0.12/1.05±0.17mmol/L),(Vit D3 37.32±1.713/8.84±3.248 ng/ml).There was no significant difference in calcium concentration between the two groups(P > 0.05).6.Logistic analysis: Birth weight is an independent protective factor of MBD in premature infants;SGA,duration of breast-feeding,initial time of enteral feeding,duration of PN,duration of respiratory supporting and hospital stay were independent risk factors of MBD in premature infants.The duration of PN is the most important independent risk factor of MBD in premature infants(OR 6.205;CI 3.359-11.463).Conclusion1.Birth weight is negatively correlated with MBD in premature infants,which is an independent protective factor.2.SGA,duration of breast-feeding,initial time of enteral feeding,duration of PN,duration of respiratory supporting and hospital stay were independent risk factors of MBD in premature infants.Among them,the duration of PN is the most important independent risk factor of MBD in premature infants(OR 6.205;CI 3.359-11.463).