ABSTRACT
An infant was born at 28-weeks’ gestation weighing 800 grams and had multiple problems during his stay in the neonatal intensive care unit (NICU), including necrotizing enterocolitis which did not require resection, delayed enteral feeding (fully fed enterally only by day 45), prolonged intravenous feeding to day 38 and conjugated hyperbilirubinaemia. He initially received ventilatory support for 4 weeks and remained on oxygen for 8 weeks. His chest x-ray at 7 weeks age showed patchy lung disease, but no fractures. He had biochemical profiles undertaken weekly during his stay in the NICU; his serum phosphate was recorded on two occasions as being <1.0 mmol/L (normal range >1.5 mmol/L); calcium, parathyroid hormone (PTH) and vitamin D were all within the normal range. He was discharged home at 38 weeks’ equivalent gestation, but was readmitted 4 weeks later with increased work of breathing and an episode of possible apnoea. His oblique chest x-ray (Image 112) revealed healing fractures of the fifth and sixth left posterior ribs as shown. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig112.jpg"/>
What are the factors in this infant that contribute to increased fracture risk?
256Prematurity and diseases during the neonatal period can adversely affect bone health. 1 , 2 Factors in prematurely born infants that contribute to an increased risk of fractures include
Gestational age ≤32 weeks
Metabolic bone disease of prematurity, suggested by low PO4 estimates
Cholestatic jaundice
Prolonged total parenteral nutrition
Prolonged oxygen requirement to 36 weeks’ gestation equivalent age
Physiotherapy and procedures
