Osteopenia among Preterm Newborns and Nursing Care

C l i n M e d International Library Citation: Tosun O, Efe YS, Erdem E, Bayat M (2016) Osteopenia among Preterm Newborns and Nursing Care. Int Arch Nurs Health Care 2:039 Received: December 03, 2015: Accepted: February 26, 2016: Published: February 29, 2016 Copyright: © 2016 Tosun O, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Tosun et al. Int Arch Nurs Health Care 2016, 2:039

aged 23 weeks has increased from 0% to 65% at some health institutions thanks to scientific and technological advancements over the last 20 years, the survival rate varies from institutions to institutions [3]. It is stated that such critical diseases that progress slowly as sensory losses, neurological disorders, developmental deficits, respiratory failures, bone mineral problems (osteopenia) occur despite decreasing number of health problems that develop rapidly thanks to the increasing rate of preterm survival rate [4,5].
One of the bone mineralization problems seen in preterm newborns is osteopenia. Because osteopenia, described as poor bone mineralization, occurs during the last trimester of pregnancy and bone development period, it is often seen among preterm newborns and is thus termed as preterm osteopenia [6][7][8][9][10]. As birth weight and gestation age of newborns reduce, incidence of preterm osteaopenia increases [6,[11][12][13].
The most prevalent chronic diseases in the newborns, pharmacological agents as corticosteroids and diuretics and longterm parenteral nutrition are some of the risk factors that increase the incidence of osteopenia [6,11,14]. A loss in mechanical stimulant is also an important risk factor for preterm osteopenia [6,10,15].
In diagnosing preterm osteopenia, biochemical parameters and radiological tests are used [11,13,16]. Of these biochemical parameters; particularly in case of low Ca-P (calcium phosphorous) and high ALP (alkaline phosphatase), osteopenia is suspected. Serious osteopenia is diagnosed if ALP > 800 IU/L or P < 3.5 mg/dl is present. However; because specificity and sensitivity of biochemical parameters is not high, these parameters are only indicative for detailed examination in suspicious cases of osteopenia [11].

Biochemical Parameters used Diagnosis of Preterm Osteopenia
Diagnosis of osteopenia can be done more accurately with the measurement of bone mineral content (BMC) or histological examination (Table 1). Various screening methods have been developed in order to detect changes in bone mass because histological examination is not suitable for newborns [11,17]. Of these screening methods; SPA (Single Photon Absorptiometry) and DPA (Dual Photon Absorptiometry) perform measurements with radioactive isotopes while QCT (Quantitative Computed Tomography) and DEXA (Dual energy X-ray absorptiometry) perform measurements with X-rays. Apart from SPA, DPA, QCT and DEXA techniques; QUS

Abstract
Incidence of preterm birth has been increasing since 1980s. Despite this increase in the incidence, survival rate of preterm newborns has been going up although it changes depending on gestational age. It is stated that such critical diseases that progress slowly as sensory losses, neurological disorders, developmental deficits, respiratory failures, bone mineral problems occur despite decreasing number of health problems that develop rapidly thanks to the increasing rate of preterm survival rate. One of the bone mineralization problems seen in preterm newborns is osteopenia. Because osteopenia, described as poor bone mineralization, occurs during the last trimester of pregnancy and bone development period, it is often seen among preterm newborns and is thus termed as preterm osteopenia. As birth weight and gestation age of newborns reduce, incidence of preterm osteaopenia increases. In diagnosing preterm osteopenia, biochemical parameters and radiological tests are used. Preterm osteopenia may lead to fractures in long bones, respiratory insufficiency due to softening or fractures of ribs, inability to leave ventilator during newborn period as well as retardation of tooth development and short stature in future. Therefore, it is highly important to prevent preterm osteopenia. First intervention against preterm osteopenia is to prevent disease progress. Enabling preterm newborns to be fed with fortified breast milk or formula with calcium and phosphorous supplements may fail in preventing preterm osteopenia. Besides; osteopenia and osteopenia-related complications may be prevented by offering daily physical activities that have no adverse effects to preterm newborns who suffer from movement restrictions. It is suggested that nurses who are responsible for the protection, maintenance and development of health can make contributions to prevent osteopenia by assessing behaviors of the newborns with the health care team and providing nutritional supplements, proper treatment modalities and physical activity programs. Thus, undesired results including long hospital stay and repeated hospitalizations that will worsen general physical status of preterm newborns and will increase cost of health care can be avoided.

Introduction
Incidence of preterm birth has been increasing since 1980s. Despite this increase in the incidence, survival rate of preterm newborns has been going up although it changes depending on gestational age [1,2]. Although survival rate of preterm newborns ISSN: 2469-5823 Tosun  (Quantitative Ultrasound) uses frequencies of sound waves. Today; QUS technique is preferred because it has a reference database for preterm newborns, it enables examination of newborn in incubator and it is a radiation-free technique [11,13,15,16].
Preterm osteopenia may lead to fractures in long bones, respiratory insufficiency due to softening or fractures of ribs, inability to leave ventilator during newborn period as well as retardation of tooth development and short stature in future [18,19]. Therefore, it is highly important to prevent preterm osteopenia. Studies on preterm osteopenia have generally focused on nutritional variables [1,[20][21][22]. Today's commercial preparates can probably meet the needs of term newborns but fail in providing enough mineral support for extra needs of preterm newborns [6,23]. Mineral support can be made by using formula or breast milk fortifiers among preterm newborns and by adding calcium and phosphorus in total parenteral nutrition solutions among newborns that are unable to be fed [14,24]. Also; it is thought that postnatal estrogen and progesterone replacement therapy may help prevent osteopenia [6]. The relevant studies done by Trotter et al. reported that bone mineralization was not affected in the control group in which only mineral support was provided but hormone replacement therapy given together with mineral support helped increase bone mineral [25][26][27]. Some studies demonstrated that inactivity may cause poor bone mineral density [28][29][30]. Inactivity increases risk of osteopenia development more and more among preterm newborns who receive long hospital stay and standard care with minimal stimulus. It was detected that daily physical activities reduce the weakening of bone strength among preterm newborn and increase body weight [31][32][33][34].
First intervention against preterm osteopenia is to prevent disease progress. Enabling preterm newborns to be fed with only fortified breast milk or only formula with calcium and phosphorous supplements may fail in preventing preterm osteopenia. Particularly; if there are more than one risk factors for preterm osteopenia; phosphorous, calcium and D vitamin supplements may be needed. Besides; osteopenia and osteopenia-related complications may be prevented by offering daily physical activities that have no adverse effects to preterm newborns who suffer from movement restrictions. It is suggested that nurses who are responsible for the protection, maintenance and development of health can make contributions to prevent osteopenia by assessing behaviors of the newborns with the health care team and providing nutritional supplements, proper treatment modalities and physical activity programs. Thus, undesired results including long hospital stay and rehospitalizations that will worsen general physical status of preterm newborns and increased cost of health care can be avoided.