RSS-Feed abonnieren
DOI: 10.1055/s-0032-1310520
Physical Therapy Reduces Bone Resorption and Increases Bone Formation in Preterm Infants
Publikationsverlauf
13. September 2011
29. Dezember 2011
Publikationsdatum:
06. Juli 2012 (online)
![](https://www.thieme-connect.de/media/ajp/201208/lookinside/thumbnails/10.1055-s-0032-1310520-1.jpg)
Abstract
Aim To evaluate bone metabolism in newborn preterm infants before and after a physical therapy protocol.
Method This randomized controlled clinical trial included 30 newborn preterm infants with gestational age ≤35 weeks and appropriate weight for gestational age, who were randomized into control group (CG) and physiotherapy group (PG). The PG protocol consisted of 15 minutes of daily passive movements with gentle joint compression 5 days a week. Daily data were obtained on feeding and body weight. Measurements of bone-specific alkaline phosphatase (BAP) and urinary deoxypyridinoline (DPD) were collected before and after intervention in both groups. The analysis of covariance test was performed to compare the means of both groups.
Results At baseline, gestational age and corrected gestational age, birth weight, and gender were similar between both groups. Nutrient supply, length of total parenteral nutrition, and mechanical ventilation were also similar. BAP level increase in PG was 22.44 ± 3.49 U/L, whereas in CG was 2.87 ± 3.99 U/L (p = 0.003). There was a reduction of DPD levels in PG of 28.21 ± 11.05 nmol/mmol, and an increase of 49.95 ± 11.05 nmol/mmol (p < 0.001) in GC.
Conclusion The benefits of prevention and treatment of metabolic bone disease of prematurity, in addition to an adequate diet, should include these passive exercises with gentle joint compressions to improve the quality of premature infant's bones.
-
References
- 1 Frost HM. From Wolff's law to the Utah paradigm: insights about bone physiology and its clinical applications. Anat Rec 2001; 262: 398-419
- 2 Kurl S, Heinonen K, Länsimies E. Pre- and post-discharge feeding of very preterm infants: impact on growth and bone mineralization. Clin Physiol Funct Imaging 2003; 23: 182-189
- 3 Chan GM, Armstrong C, Moyer-Mileur L, Hoff C. Growth and bone mineralization in children born prematurely. J Perinatol 2008; 28: 619-623
- 4 Hovi P, Andersson S, Järvenpää AL , et al. Decreased bone mineral density in adults born with very low birth weight: a cohort study. PLoS Med 2009; 6: e1000135
- 5 Fewtrell MS, Williams JE, Singhal A, Murgatroyd PR, Fuller N, Lucas A. Early diet and peak bone mass: 20 year follow-up of a randomized trial of early diet in infants born preterm. Bone 2009; 45: 142-149
- 6 van Lingen RA, Simons SHP, Anderson BJ, Tibboel D. The effects of analgesia in the vulnerable infant during the perinatal period. Clin Perinatol 2002; 29: 511-534
- 7 Bourrin S, Palle S, Genty C, Alexandre C. Physical exercise during remobilization restores a normal bone trabecular network after tail suspension-induced osteopenia in young rats. J Bone Miner Res 1995; 10: 820-828
- 8 Miller ME. The bone disease of preterm birth: a biomechanical perspective. Pediatr Res 2003; 53: 10-15
- 9 Vickers A, Ohlsson A, Lacy JB, Horsley A. Massage for promoting growth and development of preterm and/or low birth-weight infants. Cochrane Database Syst Rev 2004; (2) CD000390
- 10 MacKelvie KJ, Petit MA, Khan KM, Beck TJ, McKay HA. Bone mass and structure are enhanced following a 2-year randomized controlled trial of exercise in prepubertal boys. Bone 2004; 34: 755-764
- 11 Larson CM, Henderson RC. Bone mineral density and fractures in boys with Duchenne muscular dystrophy. J Pediatr Orthop 2000; 20: 71-74
- 12 McIntyre L, Specker BL, Hudson P , et al. Effect of exercise on bone mineral content in infants 1 to 15 months of age. Pediatr Res 1992; 31: 97A
- 13 Andreoli A, Monteleone M, Van Loan M, Promenzio L, Tarantino U, De Lorenzo A. Effects of different sports on bone density and muscle mass in highly trained athletes. Med Sci Sports Exerc 2001; 33: 507-511
- 14 Pitukcheewanont P, Punyasavatsut N, Feuille M. Physical activity and bone health in children and adolescents. Pediatr Endocrinol Rev 2010; 7: 275-282
- 15 Turner CH. Three rules for bone adaptation to mechanical stimuli. Bone 1998; 23: 399-407
- 16 Price CP. Multiple forms of human serum alkaline phosphatase: detection and quantitation. Ann Clin Biochem 1993; 30 (Pt 4) 355-372
- 17 Riggs BL. Overview of osteoporosis. West J Med 1991; 154: 63-77
- 18 Moyer-Mileur LJ, Brunstetter V, McNaught TP, Gill G, Chan GM. Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants. Pediatrics 2000; 106: 1088-1092
- 19 Nemet D, Dolfin T, Litmanowitz I, Shainkin-Kestenbaum R, Lis M, Eliakim A. Evidence for exercise-induced bone formation in premature infants. Int J Sports Med 2002; 23: 82-85
- 20 Litmanovitz I, Dolfin T, Friedland O , et al. Early physical activity intervention prevents decrease of bone strength in very low birth weight infants. Pediatrics 2003; 112 (1 Pt 1) 15-19
- 21 Shculzke SM, Trachsel D, Patole SK. Physical activity programs for promoting bone mineralization and growth in preterm infants. Cochrane Database Syst Rev 2010; (02) CD005387
- 22 Vignochi CM, Miura E, Canani LH. Effects of motor physical therapy on bone mineralization in premature infants: a randomized controlled study. J Perinatol 2008; 28: 624-631
- 23 Saraiva LG, Lazaretti-Castro M. Marcadores bioquímicos da remodelação óssea na prática clínica. Arq Bras Endocrinol Metabol 2002; 46: 72-78
- 24 Colwell A, Russell RG, Eastell R. Factors affecting the assay of urinary 3-hydroxy pyridinium crosslinks of collagen as markers of bone resorption. Eur J Clin Invest 1993; 23: 341-349
- 25 Crofton PM, Shrivastava A, Wade JC , et al. Bone and collagen markers in preterm infants: relationship with growth and bone mineral content over the first 10 weeks of life. Pediatr Res 1999; 46: 581-587
- 26 Rauch F, Middelmann B, Cagnoli M, Keller KM, Schönau E. Comparison of total alkaline phosphatase and three assays for bone-specific alkaline phosphatase in childhood and adolescence. Acta Paediatr 1997; 86: 583-587
- 27 Watts NB. Clinical utility of biochemical markers of bone remodeling. Clin Chem 1999; 45 (8 Pt 2) 1359-1368
- 28 Eliakim A, Dolfin T, Weiss E, Shainkin-Kestenbaum R, Lis M, Nemet D. The effects of exercise on body weight and circulating leptin in premature infants. J Perinatol 2002; 22: 550-554
- 29 Jutapakdeegul N, Casalotti SO, Govitrapong P, Kotchabhakdi N. Postnatal touch stimulation acutely alters corticosterone levels and glucocorticoid receptor gene expression in the neonatal rat. Dev Neurosci 2003; 25: 26-33
- 30 Field T, Diego MA, Hernandez-Reif M, Deeds O, Figuereido B. Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants. Infant Behav Dev 2006; 29: 574-578
- 31 Moyer-Mileur LJ, Ball SD, Brunstetter VL, Chan GM. Maternal-administered physical activity enhances bone mineral acquisition in premature very low birth weight infants. J Perinatol 2008; 28: 432-437
- 32 Chen H, Miller S, Shaw J, Moyer-Mileur L. Massage therapy during early postnatal life promotes greater lean mass and bone growth, mineralization, and strength in juvenile and young adult rats. J Musculoskelet Neuronal Interact 2009; 9: 278-287
- 33 Procianoy RS, Mendes EW, Silveira RC. Massage therapy improves neurodevelopment outcome at two years corrected age for very low birth weight infants. Early Hum Dev 2010; 86: 7-11
- 34 Gfatter R, Braun F, Herkner K, Kohlross C, Hackl P. Urinary excretion of pyridinium crosslinks and N-terminal crosslinked peptide in preterm and term infants. Int J Clin Lab Res 1997; 27: 238-243
- 35 Umemura Y, Ishiko T, Yamauchi T, Kurono M, Mashiko S. Five jumps per day increase bone mass and breaking force in rats. J Bone Miner Res 1997; 12: 1480-1485
- 36 Robling AG, Burr DB, Turner CH. Recovery periods restore mechanosensitivity to dynamically loaded bone. J Exp Biol 2001; 204 (Pt 19) 3389-3399
- 37 Mora S, Weber G, Bellini A, Bianchi C, Chiumello G. Bone modeling alteration in premature infants. Arch Pediatr Adolesc Med 1994; 148: 1215-1217
- 38 Albertsson-Wikland K, Karlberg J. Natural growth in children born small for gestational age with and without catch-up growth. Acta Paediatr Suppl 1994; 399: 64-70 ; discussion 71