Prematurity Does Not Increase Early Childhood Fracture Risk - 09/12/18

Doi : 10.1016/j.jpeds.2018.11.017

Kari Wagner, MD ^1,², Scott Wagner, MD ^3,⁴, Apryl Susi, MS ², Gregory Gorman, MD, MHS ^1,², Elizabeth Hisle-Gorman, MSW, PhD ²
¹ Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD
² Department of Pediatrics, Uniformed Services University, Bethesda, MD
³ Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
⁴ Department of Orthopedic Surgery, Uniformed Services University, Bethesda, MD

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Abstract

Objective

To evaluate the impact of prematurity on fracture by age 5, controlling for medications and comorbidities of prematurity.

Study design

We performed a retrospective cohort study of infants born in Military Treatment Facilities in 2009-2010 with ≥5 years of follow-up care. Gestational age, low birth weight, comorbidities of prematurity (osteopenia, necrotizing enterocolitis, chronic lung disease, and cholestasis) and fractures were identified by International Classification of Disease, 9th Edition, codes. Pharmaceutical records identified treatment with caffeine, diuretics, postnatal corticosteroids, and antacids. Poisson regression analysis determined fracture rate by 5 years of life.

Results

There were 65 938 infants born in 2009-2010 who received care in the military health system for ≥5 years, including 3589 born preterm; 165 born at ≤28^6/7 weeks of gestation, 380 born at 29-31^6/7 weeks of gestation, and 3044 born at 32-36^6/7 weeks of gestation. Preterm birth at any gestational age was not associated with fracture rate in adjusted models. The fracture rate was increased with cholestasis, proton pump inhibitor exposure, and male sex.

Conclusions

Prematurity was not associated with fracture rate. Neonatal cholestasis and proton pump inhibitor treatment were associated with increased fractures by age 5.

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Keywords : fracture, preterm birth, cholestasis, proton pump inhibitors, metabolic bone disease, diuretics, postnatal corticosteroids

Abbreviations : ICD-9-CM, LBW, NEC, PPI

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Methods

Results

Discussion

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. Some authors are a military service member or a U.S. Government employee. This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties. The authors declare no conflicts of interest.

Portions of this study were presented at the Uniformed Services Pediatric Seminar, October 23, 2016, San Francisco, CA; the Pediatric Academic Society annual meeting, May 3, 2016, Baltimore, MD; Eastern Society for Pediatric Research Annual Meeting, March 13, 2016, Philadelphia, PA; and the Academic Pediatric Association Region IV Annual Meeting, February 20, 2016, Charlottesville, VA.