Parathyroid hormone as a marker for metabolic bone disease of prematurity

Alvaro G Moreira, L. Swischuk, M. Malloy, D. Mudd, Cynthia Blanco, C. Geary

Research output: Contribution to journalArticle

15 Citations (Scopus)

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, χ<sup>2</sup> 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<sup>-1</sup> ALP had a sensitivity of 29% and specificity of 93% for severe MBD, while a cutoff point of 180 mg dl<sup>-1</sup> 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<sup>-1</sup> or a P level <4.6 mg dl<sup>-1</sup> 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
Externally publishedYes

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Metabolic Bone Diseases
Parathyroid Hormone
Sensitivity and Specificity
Bone Diseases
Caffeine
Birth Weight
Premature Infants
ROC Curve
Glucocorticoids
Observational Studies
Alkaline Phosphatase
Newborn Infant
Prospective Studies
Students
Morbidity
Weights and Measures
Serum

ASJC Scopus subject areas

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

Cite this

Parathyroid hormone as a marker for metabolic bone disease of prematurity. / Moreira, Alvaro G; Swischuk, L.; Malloy, M.; Mudd, D.; Blanco, Cynthia; Geary, C.

In: Journal of Perinatology, Vol. 34, No. 10, 11.10.2014, p. 787-791.

Research output: Contribution to journalArticle

Moreira, Alvaro G ; Swischuk, L. ; Malloy, M. ; Mudd, D. ; Blanco, Cynthia ; Geary, C. / Parathyroid hormone as a marker for metabolic bone disease of prematurity. In: Journal of Perinatology. 2014 ; Vol. 34, No. 10. pp. 787-791.
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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.",
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