Profile of metabolic bone disease in extremely low birth weight (ELBW) and very low birth weight (VLBW) neonates

Metabolic bone disease (MBD) is an important cause of morbidity in premature, very low birth weight (VLBW), and sick infants and, if left undiagnosed, may lead to structural deformities and spontaneous fractures. The objective of the present study was to study the profile of MBD and to determine the incidence of MBD in infants ≤ 32 weeks/≤ 1250 g at birth. A total of 57 infants ≤ 32 weeks/≤ 1250 g at birth admitted in our NICU from October 2020 to July 2021 were included in the study. These infants underwent screening for MBD at 4 weeks of age. They were stratified into three groups based on their gestation (≤ 28 weeks, 29–30 weeks, 31–32 weeks). MBD was observed in 100% of extreme preterm babies and 69% of very preterm babies. Overall, the incidence of MBD was 73%. Serum phosphorus level normalized by 42–44 weeks post menstrual age (PMA) across all gestations. Alkaline phosphatase (ALP) levels normalized by 42–44 weeks only in very preterm babies. Seventeen babies ≤ 30 weeks required inorganic phosphorus supplementation in addition to calcium phosphate supplementation in order to correct the MBD. Drugs like caffeine, steroids, and furosemide have significant impact on the development of MBD. The time to reach full feeds with fortification had no statistically significant effect on the incidence of MBD as detected by serum phosphorus level and serum ALP level. The profile outlined in the present study matches the literature reports in many aspects, revealing the importance of characterizing this group for the prognosis and short- and long-term follow-up of newborns with bone metabolic disease.