Çok düşük doğum ağırlıklı yenidoğanda osteopeni ve femur kırığı: Bir olgu sunumu

SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2007 Mart; 14(1) Çok düşük doğum ağırlıklı yenidoğanda osteopeni ve femur kırığı: Bir olgu sunumu Hasan Çetin* , Ayşen Türedi**, Faruk Öktem***, Bumin Dündar**** *Süleyman Demirel Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları AD, Neonatoloji Bilim Dalı, Isparta **Süleyman Demirel Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları AD, Isparta ***Süleyman Demirel Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları AD, Nefroloji Bilim Dalı, Isparta ****Süleyman Demirel Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları AD, Endokrinoloji Bilim Dalı, Isparta Özet Preterm osteopenisi uzun süre hastanede izlenen preterm bebeklerde görülen önemli bir sorundur. Bu yazıda sunulan hastamız 28 haftalık, 480 gram ağırlığında doğdu ve respiratuvar distres sendromu nedeniyle yenidoğan ünitesine kabul edildi. Respiratuvar distres sendromu, neonatal sepsis ve bronkopulmoner displazi tanıları ile izlendi. Tedavisinde amikasin, furosemid, glukokortikoid ve total parenteral nutrisyon kullanıldı. Kalsiyum desteği yeterliydi fakat fosfor replasmanı yeterli miktarda sağlanamadı. Doğum sonrası 85. günde bilateral femur kırığı saptandı. Kemik stabilizasyonu ve kalsiyum, fosfor desteği ile tedavinin 4. haftasında femur kırığı düzeldi. Anahtar kelimeler: Prematürite, osteopeni, femur kırığı. Abstract Osteopenia and femur fracture in very low birth weight infant: A case report Osteopenia of preterm is a serious problem which is seen in preterm infants hospitalized for a long period. Our case was born with 28 weeks gestational age and 480 grams birth weight and it has admitted to neonatal intensive care unit because of respiratory distress syndrome. It has followed up with respiratory distress syndrome, neonatal septicemia and bronchopulmonary dysplasia. Amicasin, furocemide, glucocorticoid and total parenteral nutrition were used for treatment of infant. Calcium supplementation is sufficient but phosphor replacement could not supplied enough amount. In postnatal 85th day, bilateral femur fracture has discovered. Femur fracture healed on the 4th week of the stabilization of bone, calcium and parenteral phosphor supplementation Key words: Preterm, osteopenia, femur fracture.

Anahtar Kelimeler:

Prematürite, osteopeni, femur kýrýðý

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Berseth C.L. and Abrams S. A. Special Gastrointestinal Concerns. In: H. Taeusch W, Ballard R.A. Averys Diseases of The Newborn. 7th ed. 1998;970-973.
Barbara J. Stoll and Robert M. Kliegman. Metabolic Disturbances. In: Behrman R, Kliegman RM, l Jenson HB, eds. Nelson Textbook of Pediatrics 17th ed. Philadelphia: Saunders, 2003;610.
Berseth CL, Abrams SA. Osteopenia of Prematurity. Taeusch HW, Ballard RA. Averys Diseases of the Newborn. Seventh edition. Philedelphia WB Saunders,1998;970-975.
Backström MC, Kouri T, Kuusela AL, Sievanen H, Koivisto AM, Ýkonen RS, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganik phosphatase in metabolik bone disease of prematurity. Acta Paediatr 2000;89:867-873.
Lyon AJ, Hawkes DJ, Doran M, N McIntosh, F
Chan. Bone mineralisation in preterm infants measured by Dual enerjy radiographic densitometry. Arch Dis Child. 1989;64:919-23.
James JR, Congdon PJ, Truscott J, Horsman A, Arthur R. Osteopenia of Prematurity. Arch Dis Child 1986;61:871-76.
Horsman A, Ryan SW, Congdon PJ, Truscott. JG, James JR. Osteopenia in extremely low birth weight infants. Arch Dis Child 1989;64:485-88.
Kýzýlateþ S. Preterm osteopenisi. Ankara Üniversitesi Týp Fakültesi Mecmuasý 2002;55:217- 22.
Backstrom MC, Kuusela AL, Maki R. Metabolic bone disease of prematurity. Ann Med 1996;28(4):275-82.
Brunton JA, Weiler HA, Atkinson SA. Improvement in the accuracy of dual energy X- ray absorbtiometry for whole body and regional analysis of body composition: validation using piglets and methadologic considerations in infants. Pediatr Res. 1997; 41:590-96.
Lapillonne A, Braillon PM, Delmas PD, Salle BL. Dual-energy X-ray absorbtiometry in early life. Horm Res 1997;48:43-9.
Koo WW, Sherman R, Succop P, Ho M, Buckley D, Tsang RC. Serum vitamin D metabolites in very low birth weight infants with and without rickets and fractures. J Pediatr 1989;114:1017- 22.
American Academy of Pediatrics. Nutritional needs of low-birth weight infants. Pediatrics 1985;75:976-86.
Committee on Nutrition oh the Preterm Ýnfant, European Society of Paediatrics Gastroenterology and Nutrition. Nutrition and feeding of premature infants. Blackwell Scientific Publications, Oxford, UK 1987:117-132.
Sharp MJ, Simmer K. Fracture and fortified breast milk in an extremely preterm infant. J Paediatr Child Health. 2003;39(6):470-73.
Catache M, Leone CR. Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants. Acta Paediatr. 2003;92(1):76- 80.
Faerk J, Peitersen B, Petersen S, Michaelsen KF. Bone mineralization in premature infants cannot be predicted from serum alkaline phosphatase or serum phosphate. Arch Dis Child Fetal Neonatal Ed. 2002;87:133-136.