Abstract
Radiographic bone demineralization (BD), rickets (R) and fractures (F) have been noted anecdotally in VLBW infants but there is no prospective study of the course and outcome of the skeletal pathology. We hypothesized that BD, R and F are frequent in VLBW infants, but the lesions are self resolving with time. X-rays from 60 VLBW (birth wt <1500g) infants were taken prospectively. Birth wts were 580-1500g, gestation 24-34wks; 32B, 28W; 54 AGA and 6 SGA. Single view x-rays were taken of both forearms at 3, 6, 9 and 12mos. Other x-rays taken for clinical reasons also were reviewed. BD, R and F were determined using standard criteria. ‘Mild’ BD was regarded as normal. From 40 infants who completed the study BD occurred in 22.5%, R in 17.5%, F in 20%. BD was noted in all infants with R or F. All infants with R had F but only one infant had F without R. All abnormal x-rays were noted by 6mos, 75% by 3mos and one infant by 7wks. F occurred predominantly in extremities (8 radius and/or ulna, 3 humerus, 3 femur), 5 ribs; unusual sites included 1 scapula; 5 had multiple F. Prior to radiographic changes, 60% received parenteral nutrition (calcium 20mg, phosphorus 15.5mg/dl, vit D2 20IU/kg/d); 70% received own mother's milk or standard 20kcal/oz formula; 30% received high calcium and phosphorus formulas in varying quantities. By 9mos all F and R healed regardless of mode of therapy or diet. By 12mos, 1 infant only still had BD. We conclude 1) BD, R and F are present in 1 in 5 of VLBW infants; 2) infants with rickets are likely to have fractures; 3) if one fracture is noted other fractures are likely. Until definitive preventive measures become available, we suggest care be taken during physical manipulation of these infants.
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Koo, W., Oestreich, A., Tsang, R. et al. 683 NATURAL HISTORY OF RICKETS AND FRACTURES IN VERY LOW BIRTH WEIGHT (VLBW) INFANTS DURING INFANCY. Pediatr Res 19, 224 (1985). https://doi.org/10.1203/00006450-198504000-00713
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DOI: https://doi.org/10.1203/00006450-198504000-00713