Elsevier

The Journal of Pediatrics

Volume 207, April 2019, Pages 148-153
The Journal of Pediatrics

Original Articles
Prematurity Does Not Increase Early Childhood Fracture Risk

https://doi.org/10.1016/j.jpeds.2018.11.017Get rights and content

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 ≤286/7 weeks of gestation, 380 born at 29-316/7 weeks of gestation, and 3044 born at 32-366/7 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.

Section snippets

Methods

Using the military healthcare system database, we formed a retrospective cohort of uniformed services beneficiaries born at military treatment facilities. Infants born at military treatment facilities between October 1, 2008, and September 30, 2010 (fiscal years 2009-2010) who received care in the military health system for ≥5 years were identified and included. The military health system provides medical care to nearly 9.5 million military members, retirees, and dependents. Care is provided at

Results

There were 65 938 children born in the military health system during the study period with ≥5 years of follow-up within the military health system. Overall, 0.7% of children experienced a fracture in the first year of life, and 7% of children experienced ≥1 fracture in the first 5 years of life. There were 505 children excluded owing to diagnosed child maltreatment and one excluded owing to osteogenesis imperfecta. Children excluded owing to maltreatment had a higher fracture rate with 6.5% of

Discussion

There was no association between prematurity and fracture during the first 5 years of life in our study of children born in 2009 and 2010; this controlled for factors likely to affect bone health. Consistent with previous reported rates, we found that 0.7% of children had a fracture before 12 months of age, 7% had a fracture by 5 years of age, and that rates were not increased in children born preterm.15, 16, 17 Although the unadjusted analysis suggested that birth at ≤28 weeks of gestation may

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    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.

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