Metabolic bone disease screening practices among U.S. neonatologists

Clin Pediatr (Phila). 2014 Oct;53(11):1077-83. doi: 10.1177/0009922814535661. Epub 2014 May 27.


Preterm, low-birth-weight neonates are predisposed to metabolic bone disease (MBD). This survey aimed to assess screening, diagnostic, and treatment practices in U.S. level IIIB/IIIC neonatal intensive care units (NICUs). A 29-question anonymous online survey was e-mailed to American Academy of Pediatrics Perinatal Section members. 338 neonatologists, representing 246 IIIB/IIIC NICUs, responded. 86% reported MBD screening. Screening was primarily based on gestational age (71%), with thresholds <26 to <36 weeks. Other criteria included birth weight (64%), total parenteral nutrition duration (48%), X-ray findings (56%), diuretic use (41%), and exclusive breast-feeding (9.6%). Almost universally, diagnosis was based on elevated alkaline phosphatase, most commonly >500 U/L (58.6%). 52% used X-ray for diagnosis. Treatment included human milk fortification (83%), vitamin D (67%), calcium (65%), and phosphorus (65%) supplementation. Our survey confirms widespread awareness of MBD but highlights lack of consensus regarding definition, screening, and treatment. Further research is needed to develop and optimize strategies to prevent, recognize, and manage MBD.

Keywords: metabolic bone disease; osteopenia; prematurity; rickets; small for gestational age.

MeSH terms

  • Alkaline Phosphatase / blood
  • Bone Diseases, Metabolic / blood
  • Bone Diseases, Metabolic / diagnosis*
  • Bone Diseases, Metabolic / diagnostic imaging
  • Female
  • Health Care Surveys / methods*
  • Health Care Surveys / statistics & numerical data*
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / blood
  • Infant, Premature, Diseases / diagnosis*
  • Infant, Premature, Diseases / diagnostic imaging
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Male
  • Neonatology / methods*
  • Radiography
  • Surveys and Questionnaires
  • United States


  • Alkaline Phosphatase