早产儿代谢性骨病研究进展

早产儿代谢性骨病为新生儿期重要的慢性疾病,因早产儿钙、磷、维生素D等代谢异常等导致的骨矿物质含量下降,骨小梁数量减少、骨皮质变薄等,严重时可有佝偻病样表现,甚至出现骨折。早产儿的低胎龄和低出生体质量为代谢性骨病的重要危险因素,诊断依靠临床表现、实验室、影像学、超声学等检查。治疗需加强被动运动,补充钙、磷、维生素D,加强预防等。早发现、早诊断、早治疗,可减少代谢性骨病后遗症的发生率,减轻对早产儿的远期影响。     

新生儿佝偻病

新生儿佝偻病始于母孕期,是由于钙、磷和(或)维生素D缺乏所引起的钙磷代谢失常,可造成骨骼基质钙盐沉着障碍和(或)骨样组织过多积聚的代谢性骨病.现就目前该病在足月儿及早产儿中的临床表现、诊治、预防及研究进展等进行介绍.     

美国肠内肠外营养学会临床指南——有代谢性骨病风险新生儿的营养支持

30年前研究发现,早产儿尤其是极低出生体重儿患代谢性骨病、身高增长延缓、佝偻病的风险增高。随着新生儿重症监护技术的发展,上述情况发生率持续升高。最近报道55％出生体重〈1000g和23％出生体重〈1500g的早产儿骨矿化不足。约80％的骨矿物质储存发生在胎儿宫内发育的最后3个月,先天储存不足使早产儿发生代谢性骨病的风险更高。临床上很难确定早产儿在新生儿期的矿物质摄入是否充足,因此,如果这些早产儿出生时即存在矿物质缺乏往往此后会更加严重。然而,并非只有早产儿会发生代谢性骨病,足月儿也存在代谢性骨病的高危因素。     

早产儿代谢性骨病防治进展

早产儿代谢性骨病是早产儿常见的并发症,对其生存质量会造成重要影响,甚至增加成年期骨质疏松的风险。早期干预能有效地减少代谢性骨病的发生,改善早产儿预后。该文对早产儿代谢性骨病的防治进展作一综述。     

早产儿代谢性骨病诊治的研究进展

早产儿代谢性骨病(MBD)是由于多种因素引起钙磷代谢紊乱导致骨矿物质含量减少,从而引起临床、生化及骨影像学相关改变,多发生于极低和超低出生体重儿。临床症状通常发生在生后6~12周,主要表现为呼吸困难、长时间依赖呼吸机治疗、佝偻病样表现,严重者甚至骨折。目前MBD主要依赖生化标记物、放射学及超声学等进行诊断。由于早产儿MBD的临床表现发生较晚,故对于高危人群进行早期筛查及预防有重要意义。     

早产儿代谢性骨病

目前早产儿营养管理明显改善,如早期肠内外营养的建立、母乳强化剂的使用、配方奶营养成分的改变及临床技能的进步等,使早产儿代谢性骨病的发生率有所降低.     

合并骨折的早产儿代谢性骨病临床分析及随访

目的分析合并骨折的早产儿代谢性骨病患儿临床资料及随访情况,为其防治提供指导依据。方法对2009年11月至2013年12月我院新生儿重症监护室确诊合并骨折的早产儿代谢性骨病患儿临床资料进行回顾性分析,包括一般资料、临床表现、辅助检查、治疗、转归及随访情况。结果共确诊5例患儿,均为男性,出生胎龄〈32周,出生体重≤1000 g,3例为小于胎龄儿,3例母亲重度子痫前期或重度子痫。5例均有反复喂养不耐受,胃肠外营养时间≥30天,3例呼吸机辅助通气时间≥20天。发现骨折时间分别为：生后6-7周3例,生后11周1例,生后17周1例;4例表现局部肢体肿胀。X线显示骨折形成,血钙无异常,碱性磷酸酶高于正常,4例血磷低于正常。2例绷带固定,1例双下肢皮牵引、双下肢悬吊位、小儿髋关节吊带固定治疗,1例患侧上肢功能位制动,1例未予特殊处理。随访患儿骨折均愈合良好,肢体对称、活动无明显异常。结论合并骨折的早产儿代谢性骨病多见于男性超低出生体重儿,好发于校正胎龄36~40周,与钙磷储备少、生后早期钙磷摄入不足及应用类固醇激素等药物有关,近期预后良好。     

支气管肺发育不良早产儿早期肺外合并症的临床分析

目的 通过对支气管肺发育不良(bronchopulmonary dysplasia,BPD)早产儿生后早期脑室周围-脑室内出血(periventricular intraventricular hemorrhage,PVH-IVH)、脑白质损伤、胃肠外营养相关性胆汁淤积综合征(parenteral nutrition associated cholestasis,PNAC)及代谢性骨病发病情况的临床分析,以期对BPD患儿肺外并发症的预防和监测进行指导.方法 回顾性分析2014年9月至2015年12月于中国医科大学附属盛京医院新生儿病房住院并明确诊断BPD的87例早产儿(BPD组),随机选择同期住院非BPD早产儿90例为对照组(非BPD组),分析两组PVH-IVH、脑白质损伤、PNAC及代谢性骨病等肺外并发症的发生率.结果 BPD组早产儿PVH-IVH发病率[26.4%(23/87)]高于非BPD组[11.1%(10/90)] (P＜0.01),其中BPD组Ⅰ~Ⅱ级PVH-IVH发病率也明显升高[24.1%(21/87) 比 11.1%(10/90)](P＜0.05),而Ⅲ~Ⅳ级PVH-IVH发生率两组比较差异无统计学意义(P＞0.05).BPD组早产儿脑白质损伤发生率[33.3%(29/87)]明显高于非BPD组[16.7%(15/90)] (P＜0.05),其中的严重类型脑室周围白质软化的发生率BPD组也明显增高[13.7%(12/87) 比 2.2%(2/90)](P＜0.05).此外,BPD组早产儿PNAC[22.9%(20/87) 比 5.5%(5/90)]、代谢性骨病[17.2%(15/87) 比 3.3%(3/90)]及代谢性骨病中有影像学改变[6.9%(6/87) 比 0]的发生率均高于非BPD组,差异均有统计学意义(P＜0.05).结论 BPD患儿较非BPD早产儿更易合并PVH-IVH、脑白质损伤、PNAC及代谢性骨病等早期肺外并发症,生后早期合理预防及定期监测肺外并发症的发生对提高BPD患儿生存质量至关重要.     

极低/超低出生体重早产儿代谢性骨病危险因素的全国多中心调查

目的 分析极低/超低出生体重(very/extremely low birth weight,VLBW/ELBW)早产儿代谢性骨病(metabolic bone disease of prematurity,MBDP)的发生率及危险因素.方法 回顾性调查2013年9月1日至2016年8月31日全国多中心61786例新生...     

早产儿支气管肺发育不良相关肺外并发症研究进展

早产儿支气管肺发育不良(bronchopulmonary dysplasia, BPD)是在肺发育不成熟的基础上, 由多种因素共同作用导致肺泡化障碍而形成的一种慢性肺部疾病, 往往需要长期的氧疗或反复机械通气治疗。BPD患儿受多种因素影响, 除肺部病变外易合并肺外并发症, 如脑白质损伤、胆汁淤积症和代谢性骨病等。因此, 明确早产儿BPD与其相关并发症的关系, 了解导致肺外并发症发生的高危因素, 对改善BPD患儿的远期预后有重要意义。     

早产儿代谢性骨病临床管理专家共识（2021年）（英文翻译）

早产儿代谢性骨病（metabolic bone disease of prematurity,MBDP）是由于机体钙磷代谢紊乱导致骨矿物质含量减少的全身性骨骼疾病。我国目前对MBDP尚缺乏深入研究和系统认识,在临床管理方面存在很多不规范之处。现基于国内外相关研究,采用证据推荐分级的评估、制定与评价方法（Grading of Recommendations Assessment,Development and Evaluation）,制定MBDP临床管理专家共识,从MBDP的高危因素、筛查/诊断、预防、治疗及出院后随访等5个方面提出推荐意见,旨在为相关从业人员提供 MBDP临床管理的建议,以减少MBDP的发生及改善其近远期预后。     

Increased survival of low birth weight infants: impact on the incidence of retinopathy of prematurity

Retinopathy of prematurity is a retinal vascular disease that occurs only in premature infants. Because of concern that the occurrence of this potentially blinding disease is increasing, a retrospective chart review was undertaken to compare the incidence of retinopathy of prematurity at the University of Washington during the years 1981 to 1984 with previously published data collected at the same institution during the years 1968 to 1980. During 1981 to 1984, there was an increase in the annual numbers of admissions and survivors weighing 1750 g at birth; the survival rate increased significantly (P less than .000001). A trend toward an increased risk for proliferative retinopathy of prematurity (P = .057) during 1981 to 1984 period was noted, but the number of "excess cases" was calculated to be only 6 per year. The remainder of the additional cases, 19 annually, were due to increased survival of infants at risk. Thus, the "second epidemic" of retinopathy of prematurity is largely due to improved survival of low birth weight infants rather than to new iatrogenic factors. In infants with proliferative retinopathy of prematurity, there was a previously unreported association between increased severity of disease and lower birth weight (P = .015). There were four children with severe bilateral visual loss due to retinopathy of prematurity identified during the 1981 to 1984 period, whereas only one bilaterally blind infant was noted during the preceding 12.7 years.     

Avoidance and treatment of retinopathy of prematurity

Retinopathy of prematurity is a blinding eye disease of premature infants. It is increasing in incidence as more babies of lower birth weights survive. Although in the 1940s and 1950s the major predisposing factor was high oxygen exposure, the main risk factor now is birth weight less than 1,000 g. Retinopathy of prematurity can be classified into several distinct stages, which progress in a typical manner. Once the stage of threshold is reached, the eye has a 50% chance of becoming blind. At this stage, laser peripheral retinal photo ablation or peripheral cryo ablation may cause the neovascularization to regress and preserve vision. The treatment is not effective in all cases, however, and a large number of children continue to become blind each year because of this devastating disease. New microsurgical techniques such as lens-sparing vitrectomy and modified scleral buckle for tiny eyes have improved the outcome for some children. Prevention is the best hope to eradicate blindness caused by this disorder, and manipulations of the metabolic and neonatal intensive care unit environment are currently being studied.     

Measurement of bone mineral content in the term and preterm infant

We tested the best anatomic site, reliability, and reproducibility of single-photon absorptiometric bone density measurements in premature and term newborns. Humerus and radius measurements were compared using a commercially available densitometer. The humerus was a more reliable site of measurement, particularly in the very-low-birth-weight infant. Normal ranges of humerus bone mineral content (BMC) were defined for infants of 24 to 42 weeks' gestational age at birth. Humerus BMC correlated with gestational age and birth weight of patients. We conclude that bone densitometer measurements can be successfully performed, even in very-low-birth-weight infants, when the humerus is used as the measurements site. We define normal humerus BMC values for use in diagnosis and evaluation of efficacy of treatment in infants who are at higher risk for osteopenia of prematurity.     

Perinatal factors associated with retinopathy of prematurity

The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed thc relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO₂ and pCO₂ values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%)). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step-wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta-blocking agents by the mother before birth were found to be associated with the development of retinopathy or prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.     

Perinatal factors associated with retinopathy of prematurity

The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed thc relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO₂ and pCO₂ values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step-wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta-blocking agents by the mother before birth were found to be associated with the development of retinopathy or prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.     

Metabolic bone disease of prematurity – an overview

With improved survival of extreme preterm and very low birth weight infants, there has been an increased incidence of metabolic bone disease (MBD). The last couple of decades have seen better awareness of the condition which in turn has led to improvement in the management and prevention of MBD. MBD occurs because there is difficulty in matching intrauterine mineral accretion rate after birth. The lack of a single specific and sensitive diagnostic test frustrates early diagnosis in many babies. Investigations like dual energy X-ray absorptiometry (DEXA) and quantitative ultrasound scanning are helpful in establishing a diagnosis but currently used mostly in research studies. A pragmatic approach for paediatricians is to pre-empt the formal diagnosis and supplement those at risk with adequate minerals and vitamin D, whilst monitoring the blood markers of MBD. Despite the noticeable short-term complications and stunting effect on childhood height, the prognosis of MBD is generally good. The aim of this article is to provide the reader with an improved understanding of the aetiopathogenesis, and offer some practical guidance on when and how to investigate and manage the metabolic bone disease of prematurity.     

Bone disease of prematurity

Bone disease of prematurity is a complication of preterm birth. This article reviews the aetiology, treatment and prevention of bone disease of prematurity. Provision of adequate nutrition including energy, protein, and minerals is required for both treatment and prevention. Screening for bone disease is controversial. While further research is required quantitative ultrasound appears to be a promising tool for screening and monitoring response to therapy. Further research is needed before recommending physical activity to prevent bone disease of prematurity.