A premature infant is at risk for osteopenia. Normally a significant amount of bone mineralization occurs during the third trimester which is missed by a premature infant.
Risk factors for osteopenia of prematurity:
(1) gestational age at birth: <= 28 weeks, <= 32 weeks, OR <= 34 weeks
(2) birthweight < 1500 grams
(3) total parenteral nutrition > 4 weeks
(4) course of diuretics and corticosteroids
Serum alkaline phosphatase is elevated with various cut-offs:
(1) > 500 IU/L
(2) > 600 IU/L
(3) > 4 times the upper limit of normal
It is important to exclude liver disease as the cause for the elevation.
The diagnosis may be confirmed by radiographs of the forearm and wrist.
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