In children with a birth weight of 1000 g and a gestation 26-28 weeks and below at the lack of prevention of developing severe bone demineralization, which in some children may lead to pathological fractures.
Manifestations of this syndrome in the form of osteoporosis may also occur in children with more weight and greater gestational age, pathological fractures of tubular bones, caused him syndrome are observed, as a rule, only children with a weight up to 1000 g and a gestation less than 29 weeks.
Basic mechanisms of development of the syndrome of osteopenia of prematurity can be divided into 4 groups:
- the lack of accumulation of the product of calcium and phosphorus and a limited intake of these elements in the early postnatal period;
- malabsorption of calcium and phosphorus in the intestine;
- excessive excretion of calcium in the urine;
- iatrogenic factors.
Syndrome osteopenia of prematurity contributes to intrauterine malnutrition, BPD and state, preventing long-term enteral nutrition.
The clinical picture of the syndrome of osteopenia in premature infants consists of two components: radiographic changes of the affected bone and the external signs of these disorders.
The first manifestation of focal osteoporosis starts at the age of 14-30 days and affect a growing area of tubular bones, scapula, vertebrae, iliac bone. Gradually, the process progresses to the 50-80-th day of life captures the region of the diaphysis of tubular bones and may acquire a generalized character.
It should be noted that on the plain radiographs for signs of osteoporosis become apparent when bone demineralization is more than 30%.
The vast majority of children predisposed to this pathological condition, osteopenia of prematurity outwardly asymptomatic and detected incidentally on radiographs of the chest in the form of osteoporosis, cracks and fractures in the rib area.
The fractures of the ribs may occur in the first month of life, they are asymptomatic and diagnosed as incidental findings on radiographs of the lungs in the mi de of fresh fractures or the formation of blisters.
To clinically severe forms of osteopenic syndrome include fractures of tubular bones. The clinical picture reflects the extent of damage and the localization process from subtle changes according to the type of fracture "green twigs" in the distal parts of forearm bones to a coarse fracture of a femur with displacement.
The long bone fractures are very rare, especially nowadays, on the background of the targeted prevention of osteopenic syndrome, and localized mainly in the region of the humerus or bones of the forearm. In respect of fractures of the tibia and fibula clear information we do not have. With regard to the femur fracture, it is extremely rare, and its development required a combination of almost all factors involved in the pathogenesis of osteopenia in premature infants.