Assessment of risk factors for osteopenia development in premature babies

Abstract

Neonatal osteopenia (KB 61.3 (ICD-11)) – violation of mineral exchange of bone tissue (BT) of premature babies (PB). Predicting and detection of osteopenia is the key to its successful control.

Aim. The aim of the article was to determine risk factors influencing the formation of neonatal osteopenia of PB and during the term of intensive care / postintensive nursing.

Materials and methods. Ultrasound densitometer Sunlight Omnisense 9000 was used to measure the ultrasound speed in BT (SOS, m/s) with estimation Z-score (SD) according to gestational age of 56 PB and 20 mature babies (control group) in the early neonatal age. Verification of osteopenia was carried out under the WHO guidelines for radiation methods by Z-score indicator less than SD by -1.0. Estimation of Z-score -2.0 SD and less was attributed to ultra-low indicators. The characteristics of obstetric and gynecological, somatic anamnesis and pregnancy course of premature babies’ mothers, factors of PB postnatal development that influence the formation of BT were studied.

Results. Children born at 33 weeks or earlier are 3.23 times more likely (OR = 3.23; CI 95 % [1.08; 9.70]) to develop BT demineralization by the corresponding term of birth than other PB. The chances of ultra-low SOS by Z-score are 14.22 times higher (OR = 14.22; CI 95 % [3.29; 61.57]) in PB born at 32 weeks of gestation and earlier. Extragenital diseases, clinical signs of calcium deficiency in mothers, and women’s intake of calcium and vitamin D3 during pregnancy did not have a statistically significant difference (p > 0.05) in the studied PB and control group. The mother’s preeclampsia increases the chances of insufficient BT mineralization by 5.47 times (OR = 5.47; CI 95 % [1.07; 27.93]), second parity pregnancy (and subsequent ones) – by 4.51 times (OR = 4.51, CI 95 % [1.38; 14.80]). The factors of the ratio of the duration of mechanical ventilation relative to the total time of PB treatment, the duration of parenteral feeding have an inverse correlation (moderate (r = -0.42, р < 0.05) and significant (r = -0.51, р < 0.05) respectively) with a decrease in SOS to low Z-score.

Conclusions. In PB born at 32 weeks of gestation and earlier, the chances of ultra-low SOS indicators by Z-score are 14.22 times higher (OR = 14.22; CI 95 % [3.29; 61.57]). The following factors predicts insufficient mineralization of BT according to SOS indicators according to the Z-score: mother’s second parity pregnancy (and subsequent ones), preeclampsia, parenteral feeding of PB for more than 8 days (Se = 75.00 %, Sp = 71.87 %, p < 0.0001), duration of mechanical ventilation, which is more than 6.48 % of the total time of PB treatment (Se = 86.67 %, Sp = 59.38 %, p < 0.046).