What is Metabolic Bone Disease?
Metabolic Bone Disease or osteopenia of prematurity are terms used to describe reduction in the mineral bones that can occur within 6-12 weeks after preterm birth. This puts baby at higher risk developing fractures.
What are the signs and symptoms?
Babies don’t often show any signs of Metabolic Bone Disease. Often the first sign is abnormal bone markers in the blood tests. Sometimes the baby can be more unsettled than usual or have a swollen, red and painful limb.
What causes it?
Certain things can increase the risk of developing Metabolic Bone Disease such as:
- Being born below 32 weeks, birth weight <1800g, male gender
- Prolonged intravenous nutrition
- Having feeds held off or having a small amount of milk
- Being on some medications such as steroid, diuretics
- Vitamin D deficiency
- Being on sedation/nerve blocking
- Chronic Lung Disease
How is it diagnosed?
Blood and urine tests are used to identify levels of calcium and phosphate, vitamin D levels, Alkaline Phosphatase and parathyroid hormone. This can help to diagnose Metabolic Bone Disease.
Sometimes when doing x-rays we can also notice bones looking less dense, a fracture of healing fracture.
What treatments are available?
The main treatment is to provide best nutrition possible in order to prevent Metabolic Bone Disease. Calcium and phosphate supplements can also be given. Extra supplementation of vitamin D is provided if the levels are found to be low.
A multidisciplinary team reviews the nutrition and blood levels to ensure appropriate levels are maintained as much as possible.
It is likely extra vitamins may be needed once baby leaves NICU.
Medication that can have an impact are considered carefully to see if they can safely be discontinued.
Fractures heal very well and usually do not require treatment. We can provide pain relief to ensure babies are comfortable and try to limit the amount of movement in order to prevent further pain.
If your baby is at risk of Metabolic Bone Disease we will put a sign on their cot to make people aware that extra care is needed when handling the baby. Despite these precautions fractures can still occur sometimes.
Please feel free to ask for support or any questions to Nurses and Doctors.