Parathyroid hormone as a marker for metabolic bone disease of prematurity

A. Moreira, L. Swischuk, M. Malloy, D. Mudd, C. Blanco, C. Geary

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Abstract

Objective: To compare parathyroid hormone to alkaline phosphatase as a serologic marker for metabolic bone disease (MBD) in preterm infants. Study Design: An 18-month prospective observational study in neonates withbirth weight <1250 g. Simultaneous serum parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca) and phosphorus (P) were measured at scheduled intervals during hospitalization. At 6 weeks of age, MBD was evaluated using knee radiographs. Comparisons were analyzed using multivariate logistic regression, receiver operating characteristic (ROC) curves, χ2 and Student t-test.Result:Fourty-nine infants were included in the study: 7 with severe and 42 with mild MBD. Using ROC curves, at 660 U l-1 ALP had a sensitivity of 29% and specificity of 93% for severe MBD, while a cutoff point of 180 mg dl-1 gave PTH a sensitivity of 71% and specificity of 88%. Infants with severe bone disease had a lower birth weight, 21-day serum P, an increased use of glucocorticoids and caffeine, and more likely to have major neonatal morbidities.Conclusion: PTH is an early marker with better sensitivity than ALP in screening for MBD. At 3 weeks chronologic age, a PTH level >180 mg dl-1 or a P level <4.6 mg dl-1 yielded a sensitivity of 100% and specificity of 94% for severe MBD.

Original languageEnglish (US)
Pages (from-to)787-791
Number of pages5
JournalJournal of Perinatology
Volume34
Issue number10
DOIs
StatePublished - Oct 11 2014

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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