Diagnosis and prevention of MBD/ Osteopenia/ Rickets of prematurity
Metabolic Bone Disease of Prematurity is aa frequent complication in preterm infants, especially very low birth weight babies in the NICU. But how do you recognize it, diagnose it, and manage it effectively?
In Part 2 of this neonatal education series, Dr. Tala explains the diagnosis and management of metabolic bone disease of prematurity, including the key laboratory markers, imaging findings, nutrition strategies, supplementation, and prevention approaches.
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'Osteopenia of Prematurity' or 'Rickets of Prematurity' or Metabolic Bone Disease all refer to the same process: premature babies developing weak bones because it's so hard to feed a baby enough calcium and phosphorous. Watch this video to learn about the risk factors, the causes, and the general incidence of MBD.
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 18 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Biochemical Markers of Bone Remodeling in Multiple Myeloma - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Osteoblast-activation-Through-stimulators-the-osteoblasts-produce-enzymes-such-as-ALP_fig1_227001716
Alkaline Phosphatase distribution in body: https://labpedia.net/alkaline-phosphatase-alp/
Stacy E. Rustico, Andrew C. Calabria, Samuel J. Garber, Metabolic bone disease of prematurity, Journal of Clinical & Translational Endocrinology, Volume 1, Issue 3, 2014, Pages 85-91,ISSN 2214-6237, https://doi.org/10.1016/j.jcte.2014.06.004.
Endocrine Diseases of Newborn: Epidemiology, Pathogenesis, Therapeutic Options, and Outcome “Current Insights Into Disorders of Calcium and Phosphate in the Newborn” - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Factors-contributing-to-Metabolic-Bone-Disease-of-Prematurity_tbl2_349083519
TRP= how much Phosphorous is reabsorbed vs excreted in urine: https://clinicalpub.com/renal-tubular-reabsorption-and-secretion/
Calcidiol (25-hydroxyvitamin D) Is = in babies with OR without rickets: https://www.empirical.health/blog/vitamin-d-is-a-hormone/
Faienza MF, D'Amato E, Natale MP, Grano M, Chiarito M, Brunetti G, D'Amato G. Metabolic Bone Disease of Prematurity: Diagnosis and Management. Front Pediatr. 2019 Apr 12;7:143. doi: 10.3389/fped.2019.00143. PMID: 31032241; PMCID: PMC6474071.
Shiva S, Rezazadeh K, Amiraslanzadeh A, Mehramuz B, Yeganehdoost S, Mahallei M. Continuous versus intermittent bolus infusion of calcium in preterm infants receiving total parenteral nutrition: a randomized blind clinical trial. BMC Pediatr. 2024 Jan 12;24(1):35. doi: 10.1186/s12887-023-04516-x. PMID: 38216920; PMCID: PMC10785396.
Rustico SE, Kelly A, Monk HM, Calabria AC. Calcitriol treatment in metabolic bone disease of prematurity with elevated parathyroid hormone: A preliminary study. J Clin Transl Endocrinol. 2014 Dec 22;2(1):14-20. doi: 10.1016/j.jcte.2014.12.001. PMID: 29159104; PMCID: PMC5685017.
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***TIMESTAMPS***
00:00 – Introduction
00:35 – How Is Metabolic Bone Disease Diagnosed?
09:38 – Management of MBD
19:26 – Gentle Handling & Physical Therapy
21:00 – Final thoughts & Key Takeaways
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*Disclaimer*: This video is intended for educational purposes only, and while we strive to give the most accurate information, errors may occur. Subsequently, this video should not be a replacement for medical advice.
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