早产儿代谢性骨病临床管理专家共识（2021年）

doi:10.7499/j.issn.1008-8830.2105152

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Abstract Metabolic bone disease of prematurity (MBDP) is a systemic bone disease with a reduction in bone mineral content due to disorder of calcium and phosphorus metabolism. There is still a lack of in-depth research and systematic understanding of MBDP in China, and there are many irregularities in clinical management of this disease. Based on relevant studies in China and overseas, Grading of Recommendations Assessment, Development and Evaluation was used to develop the expert consensus on the clinical management of MBDP, which provides recommendations from the following five aspects: high-risk factors, screening/diagnosis, prevention, treatment, and post-discharge follow-up of MBDP, so as to provide relevant practitioners with recommendations on the clinical management of MBDP to reduce the incidence rate of MBDP and improve its short- and long-term prognosis.

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	Articles by authors
	Yan-Mei CHANG
	Xin-Zhu LIN
	Rong ZHANG
	Xi-Hong LIU
	Xiao-Mei TONG
	Ping-Yang CHEN
	Zhi-Chun FENG

Key words： Metabolic bone disease Expert consensus Osteopenia Bone mineralization and growth Preterm infant

Received: 01 June 2021

Corresponding Authors: Tong X-M, Email: tongxm2007@126.com E-mail: tongxm2007@126.com

Cite this article:

Yan-Mei CHANG,Xin-Zhu LIN,Rong ZHANG et al. Expert consensus on clinical management of metabolic bone disease of prematurity (2021)[J]. CJCP, 2021, 23(8): 761-772.

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http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2105152 OR http://www.zgddek.com/EN/Y2021/V23/I8/761

	Rustico SE, Calabria AC, Garber SJ. Metabolic bone disease of prematurity[J]. J Clin Transl Endocrinol, 2014, 1(3): 85-91. DOI: 10.1016/j.jcte.2014.06.004. PMID: 29159088. PMCID: PMC5684970.
	Rayannavar A, Calabria AC. Screening for metabolic bone disease of prematurity[J]. Semin Fetal Neonatal Med, 2020, 25(1): 101086. DOI: 10.1016/j.siny.2020.101086. PMID: 32081592.
	Rehman MU, Narchi H. Metabolic bone disease in the preterm infant: current state and future directions[J]. World J Methodol, 2015, 5(3): 115-121. DOI: 10.5662/wjm.v5.i3.115. PMID: 26413483. PMCID: PMC4572023.
	Chacham S, Pasi R, Chegondi M, et al. Metabolic bone disease in premature neonates: an unmet challenge[J]. J Clin Res Pediatr Endocrinol, 2020, 12(4): 332-339. DOI: 10.4274/jcrpe.galenos.2019.2019.0091. PMID: 31674171. PMCID: PMC7711645.
	Kelly A, Kovatch KJ, Garber SJ. Metabolic bone disease screening practices among U.S. neonatologists[J]. Clin Pediatr (Phila), 2014, 53(11): 1077-1083. DOI: 10.1177/0009922814535661. PMID: 24872339.
	贺晓日, 梁灿, 俞元强, 等. 极低/超低出生体重早产儿代谢性骨病危险因素的全国多中心调查[J]. 中国当代儿科杂志, 2021, 23(6): 555-562. DOI: 10.7499/j.issn.1008-8830.2012055. PMID: 34130775. PMCID: PMC8213994.
	Chen WH, Yang CY, Chen HQ, et al. Risk factors analysis and prevention of metabolic bone disease of prematurity[J]. Medicine (Baltimore), 2018, 97(42): e12861. DOI: 10.1097/MD.0000000000012861. PMID: 30334994. PMCID: PMC6211899.
	8 张乐嘉, 丁国芳. 早产儿代谢性骨病[J]. 中国实用儿科杂志, 2015, 30(2): 100-104. DOI: 10.7504/ek2015020606.
	9 Schünemann H, Bro?ek J, Guyatt G, et al. GRADE handbook[EB/OL]. [2020-07-16]. https://gdt.gradepro.org/app/handbook/handbook.html.
	10 GRADEpro GDT. GRADE your evidence and improve your guideline development in health care[EB/OL]. [2020-07-10]. https://gradepro.org.
	11 BalshemH, HelfandaM, SchunemannHJ, et al. GRADE指南: Ⅲ. 证据质量分级[J]. 中国循证医学杂志, 2011, 11(4): 451-455. DOI: 10.3969/j.issn.1672-2531.2011.04.017.
	Rigo J, Pieltain C, Salle B, et al. Enteral calcium, phosphate and vitamin D requirements and bone mineralization in preterm infants[J]. Acta Paediatr, 2007, 96(7): 969-974. DOI: 10.1111/j.1651-2227.2007.00336.x. PMID: 17577338.
	Ko?odziejczyk A, Borszewska-Kornacka MK, Seliga-Siwecka J. Monitored supplementation of vitamin D in preterm infants (MOSVID trial): study protocol for a randomised controlled trial[J]. Trials, 2017, 18(1): 424. DOI: 10.1186/s13063-017-2141-y. PMID: 28893306. PMCID: PMC5594536.
	Nehra D, Carlson SJ, Fallon EM, et al. A.S.P.E.N. clinical guidelines: nutrition support of neonatal patients at risk for metabolic bone disease[J]. JPEN J Parenter Enteral Nutr, 2013, 37(5): 570-598. DOI: 10.1177/0148607113487216. PMID: 23685349.
	15 Shamir R, Turck D, Phillip M. Nutrition and Growth (World Review of Nutrition and Dietetics, Vol. 106)[M]. Basel: Karger Publishers, 2013: 181-188.
	16 Gleason CA, Juul SE. Avery's Diseases of the Newborn[M]. 10th ed. Philadelphia: Elsevier, 2018: 1347-1350.
	Zhang H, Jia Q, Piao MH, et al. Screening of serum alkaline phosphatase and phosphate helps early detection of metabolic bone disease in extremely low birth weight infants[J]. Front Pediatr, 2021, 9: 642158. DOI: 10.3389/fped.2021.642158. PMID: 33968848. PMCID: PMC8100498.
	Christmann V, Gradussen CJ, K?rnmann MN, et al. Changes in biochemical parameters of the calcium-phosphorus homeostasis in relation to nutritional intake in very-low-birth-weight infants[J]. Nutrients, 2016, 8(12): 764. DOI: 10.3390/nu8120764. PMID: 27916815. PMCID: PMC5188419.
	19 王丹虹, 陈平洋. 早产儿代谢性骨病防治进展[J]. 国际儿科学杂志, 2014, 41(5): 508-510. DOI: 10.3760/cma.j.issn.1673-4408.2014.05.016.
	20 Eichenwald EC, Hansen AR, Martin C, et al. Cloherty and Stark's Manual of Neonatal Care[M]. 8th ed. Philadelphia: Wolters Kluwer, 2017: 853-857.
	Mihatsch W, Fewtrell M, Goulet O, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: calcium, phosphorus and magnesium[J]. Clin Nutr, 2018, 37(6 Pt B): 2360-2365. DOI: 10.1016/j.clnu.2018.06.950. PMID: 30097365.
	Chacham S, Pasi R. Assisted physical exercise for preterm neonates[J]. Indian Pediatr, 2018, 55(2): 111-112. PMID:29503267.
	Harrison CM, Gibson AT. Osteopenia in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 2013, 98(3): F272-F275. DOI: 10.1136/archdischild-2011-301025. PMID: 22556204.
	Backstr?m MC, Kouri T, Kuusela AL, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity[J]. Acta Paediatr, 2000, 89(7): 867-873. DOI: 10.1111/j.1651-2227.2000.tb00395.x. PMID: 10943972.
	Hung YL, Chen PC, Jeng SF, et al. Serial measurements of serum alkaline phosphatase for early prediction of osteopaenia in preterm infants[J]. J Paediatr Child Health, 2011, 47(3): 134-139. DOI: 10.1111/j.1440-1754.2010.01901.x. PMID: 21091586.
	Viswanathan S, Khasawneh W, McNelis K, et al. Metabolic bone disease: a continued challenge in extremely low birth weight infants[J]. JPEN J Parenter Enteral Nutr, 2014, 38(8): 982-990. DOI: 10.1177/0148607113499590. PMID: 23963689.
	Figueras-Aloy J, álvarez-Domínguez E, Pérez-Fernández JM, et al. Metabolic bone disease and bone mineral density in very preterm infants[J]. J Pediatr, 2014, 164(3): 499-504. DOI: 10.1016/j.jpeds.2013.10.089. PMID: 24331689.
	Abdallah EAA, Said RN, Mosallam DS, et al. Serial serum alkaline phosphatase as an early biomarker for osteopenia of prematurity[J]. Medicine (Baltimore), 2016, 95(37): e4837. DOI: 10.1097/MD.0000000000004837. PMID: 27631238. PMCID: PMC5402581.
	Matejek T, Navratilova M, Zaloudkova L, et al. Parathyroid hormone—reference values and association with other bone metabolism markers in very low birth weight infants—pilot study[J]. J Matern Fetal Neonatal Med, 2019, 32(17): 2860-2867. DOI: 10.1080/14767058.2018.1450858. PMID: 29562766.
	Moreira A, Swischuk L, Malloy M, et al. Parathyroid hormone as a marker for metabolic bone disease of prematurity[J]. J Perinatol, 2014, 34(10): 787-791. DOI: 10.1038/jp.2014.97. PMID: 24875407.
	Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930. DOI: 10.1210/jc.2011-0385. PMID: 21646368.
	32 张会丰, 韩笑, 武姗姗. 血清25(OH)D水平对评估儿童维生素D营养状况的意义和界值[J]. 中华儿科杂志, 2015, 53(3): 164-167. DOI: 10.3760/cma.j.issn.0578-1310.2015.03.002.
	Pohlandt F, Mihatsch WA. Reference values for urinary calcium and phosphorus to prevent osteopenia of prematurity[J]. Pediatr Nephrol, 2004, 19(11): 1192-1193. DOI: 10.1007/s00467-004-1651-5. PMID: 15349764.
	Syed Z, Khan A. Bone densitometry: applications and limitations[J]. J Obstet Gynaecol Can, 2002, 24(6): 476-484. DOI: 10.1016/s1701-2163(16)31095-7. PMID: 12196854.
	Baroncelli GI. Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application[J]. Pediatr Res, 2008, 63(3): 220-228. DOI: 10.1203/PDR.0b013e318163a286. PMID: 18287958.
	Tong LT, Gopal-Kothandapani JS, Offiah AC. Feasibility of quantitative ultrasonography for the detection of metabolic bone disease in preterm infants—systematic review[J]. Pediatr Radiol, 2018, 48(11): 1537-1549. DOI: 10.1007/s00247-018-4161-5. PMID: 29907939.
	Senterre T, Rigo J. Parenteral nutrition in premature infants: practical aspects to optimize postnatal growth and development[J]. Arch Pediatr, 2013, 20(9): 986-993. DOI: 10.1016/j.arcped.2013.05.021. PMID: 23845601.
	Koletzko B, Goulet O, Hunt J, et al. Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR)[J]. J Pediatr Gastroenterol Nutr, 2005, 41 (Suppl 2): S1-S87. DOI: 10.1097/01.mpg.0000181841.07090.f4. PMID: 16254497.
	Fusch C, Bauer K, B?hles HJ, et al. Neonatology/paediatrics— guidelines on parenteral nutrition, chapter 13[J]. Ger Med Sci, 2009, 7: Doc15. DOI: 10.3205/000074. PMID: 20049070. PMCID: PMC2795370.
	Motokura K, Tomotaki S, Hanaoka S, et al. Appropriate phosphorus intake by parenteral nutrition prevents metabolic bone disease of prematurity in extremely low-birth-weight infants[J]. JPEN J Parenter Enteral Nutr, 2020. DOI: 10.1002/jpen.1993. PMID: 32789876. Epub ahead of print.
	Pereira-da-Silva L, Costa A, Pereira L, et al. Early high calcium and phosphorus intake by parenteral nutrition prevents short-term bone strength decline in preterm infants[J]. J Pediatr Gastroenterol Nutr, 2011, 52(2): 203-209. DOI: 10.1097/MPG.0b013e3181f8b295. PMID: 21240015.
	Pieltain C, de Halleux V, Senterre T, et al. Prematurity and bone health[J]. World Rev Nutr Diet, 2013, 106: 181-188. DOI: 10.1159/000342680. PMID: 23428699.
	Abrams SA, Committee on Nutrition. Calcium and vitamin D requirements of enterally fed preterm infants[J]. Pediatrics, 2013, 131(5): e1676-e1683. DOI: 10.1542/peds.2013-0420. PMID: 23629620.
	Klein CJ. Nutrient requirements for preterm infant formulas[J]. J Nutr, 2002, 132(6 Suppl 1): 1395S-1577S. DOI: 10.1093/jn/132.6.1395S. PMID: 12042465.
	45 Tsang RC, Uauy R, Koletzko B, et al. Nutrition of the Preterm Infant: Scientific Basis and Practice[M]. 2nd ed. Cincinnati: Digital Educational Publishing, Inc. 2005: 245-275.
	Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition[J]. J Pediatr Gastroenterol Nutr, 2010, 50(1): 85-91. DOI: 10.1097/MPG.0b013e3181adaee0. PMID: 19881390.
	47 Koletzko B, Poindexter B, Uauy R. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines (World Review of Nutrition and Dietetics, Vol. 110)[M]. Basel: Karger Publishers, 2014: 140-151.
	Brown JV, Embleton ND, Harding JE, et al. Multi-nutrient fortification of human milk for preterm infants[J]. Cochrane Database Syst Rev, 2016(5): CD000343. DOI: 10.1002/14651858.CD000343.pub3. PMID: 27155888.
	49 早产儿母乳强化剂使用专家共识工作组, 中华新生儿科杂志编辑委员会. 早产儿母乳强化剂使用专家共识[J]. 中华新生儿科杂志(中英文), 2019, 34(5): 321-328. DOI: 10.3760/cma.j.issn.2096-2932.2019.05.001.
	50 Kleinman RE, Greer FR. Pediatric Nutrition Handbook[M]. 7th ed. American Academy of Pediatrics: Elk Grove Village, 2014.
	Lapillonne A, O'Connor DL, Wang DH, et al. Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge[J]. J Pediatr, 2013, 162(3 Suppl): S90-S100. DOI: 10.1016/j.jpeds.2012.11.058. PMID: 23445854.
	Taylor SN, Wahlquist A, Wagner CL, et al. Functional indicators of vitamin D adequacy for very low birth weight infants[J]. J Perinatol, 2018, 38(5): 550-556. DOI: 10.1038/s41372-018-0098-7. PMID: 29743660. PMCID: PMC6382072.
	Fort P, Salas AA, Nicola T, et al. A comparison of 3 vitamin D dosing regimens in extremely preterm infants: a randomized controlled trial[J]. J Pediatr, 2016, 174: 132-138.e1. DOI: 10.1016/j.jpeds.2016.03.028. PMID: 27079965. PMCID: PMC4925243.
	Abrams SA. Dietary guidelines for calcium and vitamin D: a new era[J]. Pediatrics, 2011, 127(3): 566-568. DOI: 10.1542/peds.2010-3576. PMID: 21339264.
	Moyer-Mileur LJ, Brunstetter V, McNaught TP, et al. Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants[J]. Pediatrics, 2000, 106(5): 1088-1092. DOI: 10.1542/peds.106.5.1088. PMID: 11061779.
	Schulzke SM, Kaempfen S, Trachsel D, et al. Physical activity programs for promoting bone mineralization and growth in preterm infants[J]. Cochrane Database Syst Rev, 2014(4): CD005387. DOI: 10.1002/14651858.CD005387. PMID: 24752440.
	57 樊维琦. 早产儿骨质发育不良新进展[J]. 中国新生儿科杂志, 2010, 25(2): 122-126. DOI: 10.3969/j.issn.1673-6710.2010.02.024.
	Faienza MF, D'Amato E, Natale MP, et al. Metabolic bone disease of prematurity: diagnosis and management[J]. Front Pediatr, 2019, 7: 143. DOI: 10.3389/fped.2019.00143. PMID: 31032241. PMCID: PMC6474071.
	Tinnion RJ, Embleton ND. How to use... alkaline phosphatase in neonatology[J]. Arch Dis Child Educ Pract Ed, 2012, 97(4): 157-163. DOI: 10.1136/archdischild-2012-301633. PMID: 22761487.
	中华儿科杂志》编辑委员会, 中华医学会儿科学分会儿童保健学组, 中华医学会儿科学分会新生儿学组. 早产、低出生体重儿出院后喂养建议[J]. 中华儿科杂志, 2016, 54(1): 6-12. DOI: 10.3760/cma.j.issn.0578-1310.2016.01.003. PMID: 27470474.
	张蓉, 林新祝, 常艳美, 等. 早产儿支气管肺发育不良营养管理专家共识[J]. 中国当代儿科杂志, 2020, 22(8): 805-814. DOI: 10.7499/j.issn.1008-8830.2005080. PMID: 32800025. PMCID: PMC7441505.
	62 国家卫生和计划生育委员会办公厅. 早产儿保健工作规范[J]. 中华围产医学杂志, 2017, 20(6): 401-406. DOI: 10.3760/cma.j.issn.1007-9408.2017.06.001.
	首都儿科研究所, 九市儿童体格发育调查协作组. 2015年中国九市七岁以下儿童体格发育调查[J]. 中华儿科杂志, 2018, 56(3): 192-199. DOI: 10.3760/cma.j.issn.0578-1310.2018.03.008. PMID: 29518829.