Risk Factors Of Metabolic Bone Disease Of Prematurity

metabolic bone disease of prematurity is also known as osteopenia of prematurity.MBDP is a disease with abnormal calcium,phosphorus and other minerals caused by various causes,and increased alkaline phosphatase in blood,resulting in a decrease in bone mineral content,a decrease in the number of trabeculae,a thinning of the bone cortex,and other skeletal changes.Due to the lack of mineral reserves and insufficient vitamin D levels in premature infants,the best period of bone mineralization was missed,the lack of post-natal nutrients made it difficult to achieve catch-up growth,and the use of various invasive operations and drugs resulted in poor bone mineralization.So metabolic bone disease is more likely to occur in premature infants.The disease usually occurs from the 10 th week to the 16 th week after birth.It is usually asymptomatic in the early stage and has only biochemical changes in blood.However,rickets and even pathological fractures can occur with the progression of the disease.Metabolic bone disease in preterm infants is not rare in follow-up,but there is no uniform report on the specific incidence and possible high-risk factors leading to the occurrence of metabolic bone disease in preterm infants.This study studied and analyzed preterm infants with metabolic bone disease who were born in the affiliated Hospital of Chengde Medical College from October 2015 to July 2018 and followed up regularly to explore the high risk factors of the disease.It provides some practical guidance for the prevention and management of metabolic bone disease in preterm infants.Objective:By analyzing the high risk factors of metabolic bone disease in premature infants,the independent risk factors of metabolic bone disease in preterm infants were identified,and the understanding of the disease was improved,which provided the clinical basis for the early identification and prevention of metabolic bone disease in preterm infants.Methods:297 premature infants born in our hospital from October to May 2018 and regularly followed up were selected and divided into MBD group and non-MBDP group according to ALP and blood phosphorus.Perinatal status(pregnancy-induced hypertension,gestational diabetes mellitus,gynaecological inflammation,premature rupture of membranes);birth status(sex,gestational age,birth weight,birth asphyxia history,delivery mode,IUGR);data of duration of hospitalization(length of stay,duration of parenteral nutrition,duration of mechanical ventilation,co-infection,etc.)and drug use during hospitalization(furosemide,phenobarbital sodium,caffeine)were retrospectively analyzed.Then binary logistic regression analysis was performed on the variables that were statistically significant in the univariate analysis.Results:Among the 297 cases,the incidence of MBD was 50.17%(149 cases),There were statistically significant differences in the incidence of MBDP in different gestational ages and birth mass.The smaller the fetal age,the higher the incidence of MBDP(?2=42.091,P<0.05);the smaller the birth weight,the higher the incidence of MBDP(?2=40.651,P<0.05);The proportion of MBDP in infants with intrauterine growth retardation(IUGR)was significantly higher than that in non-MBDP group(P<0.05);The incidence of pre-existing hypertension,diabetes and gynecological inflammation and premature rupture of membranes during pregnancy was higher than that of non-MBDP group(P<0.05);The length of hospital stay,application of intravenous nutrition,and mechanical ventilation time in the MBDP group were greater than those in the non-MBDP group(P<0.05);The proportion of MBDP complicated with infection during hospitalization was significantly higher than that of non-MBDP group(P < 0.05);The use rate of furosemide,phenobarbital sodium,caffeine and other drugs in the MBDP group was higher than that in the non-MBDP group(P<0.05).Logistic regression analysis showed that gestational age,birth weight and IUGR were independent risk factors for MBDP.Conclusion:In summary,gestational age,birth weight,intrauterine growth retardation,gestational hypertension,diabetes mellitus,gynecologic inflammation and other diseases and premature rupture of membranes;Duration of hospitalization,duration of intravenous nutrition,duration of mechanical ventilation and co-infection during hospitalization,and administration of furosemide,phenobarbital sodium,caffeine and other drugs were risk factors for metabolic bone disease in preterm infants.Therefore,health care during pregnancy,prevention of preterm delivery,prevention of hypertension during pregnancy,diabetes mellitus and other diseases,early enteral nutrition after birth,reduction of intravenous nutrition time,application of protective ventilation strategy,as far as possible to reduce the duration of mechanical ventilation,reasonable use of furosemide,phenobarbital sodium,caffeine and other drugs will reduce the occurrence of MBDP to a certain extent.