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Am J Perinatol 2020; 37(03): 313-321
DOI: 10.1055/s-0039-1678559
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Passive Range-of-Motion Exercise and Bone Mineralization in Preterm Infants: A Randomized Controlled Trial

Rania A. El-Farrash
1   Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Ibrahim S. Abo-Seif
1   Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Abeer K. El-Zohiery
2   Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Gehan M. Hamed
3   Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Reham M. Abulfadl
4   Neonatal Intensive Care Unit, Maternity Hospital, Ain Shams University, Cairo, Egypt
› Author Affiliations Funding None.
Further Information

Publication History

17 September 2018

06 January 2019

Publication Date:
07 February 2019 (online)

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Abstract

Objective To assess the effect of range-of-motion exercise program on bone mineralization and somatic growth of very low birth weight (VLBW) infants.

Study Design A total of 36 VLBW infants were randomized into 18 VLBW infants receiving range-of-motion exercise and 18 VLBW control infants receiving tactile stimulation for 4 weeks. Laboratory investigations were performed at baseline and postexercise and included serum calcium, serum phosphorus (s.PO4), magnesium, alkaline phosphatase (ALP), urinary calcium/phosphate ratio, and serum carboxy-terminal cross-linked telopeptide of type 1 collagen (CTX). Dual-energy X-ray absorptiometry was performed at the end of the exercise protocol to measure bone mineral content, bone mineral density (BMD), bone area, lean mass, and fat mass.

Results The weight and the rate of weight gain were significantly higher (p < 0.001) in the exercise group compared with controls postexercise. Also, higher s.PO4, lower ALP, and lower urinary calcium/phosphate ratio were observed postexercise in the exercise group (p = 0.001, p = 0.005, and p = 0.04, respectively), whereas serum CTX showed no difference between the two groups (p = 0.254). Postexercise BMD significantly improved in the exercise group (p < 0.001) compared with controls.

Conclusion Although the sample size was small, we may be able to suggest favorable effects of range-of-motion exercise versus tactile stimulation on bone metabolism, BMD, and short-term growth in VLBW infants.

Keywords

metabolic bone disease - physical activity - bone mineral density - preterm infant

Authors' Contributions

All authors were involved in the concept, design, data collection, analysis, and drafting of the manuscript.


Supplementary Material

 

  • References

  • 1 Litmanovitz I, Erez H, Eliakim A. , et al. The effect of assisted exercise frequency on bone strength in very low birth weight preterm infants: a randomized control trial. Calcif Tissue Int 2016; 99 (03) 237-242
    CrossrefPubMedSearch in Google Scholar
  • 2 Eliakim A, Litmanovitz I, Nemet D. The role of exercise in prevention and treatment of osteopenia of prematurity: an update. Pediatr Exerc Sci 2017; 29 (04) 450-455
    CrossrefPubMedSearch in Google Scholar
  • 3 Harrison CM, Gibson AT. Osteopenia in preterm infants. Arch Dis Child Fetal Neonatal Ed 2013; 98 (03) F272-F275
    CrossrefPubMedSearch in Google Scholar
  • 4 Forbes GB. Letter: calcium accumulation by the human fetus. Pediatrics 1976; 57 (06) 976-977
    PubMedSearch in Google Scholar
  • 5 Dokos C, Tsakalidis C, Tragiannidis A, Rallis D. Inside the “fragile” infant: pathophysiology, molecular background, risk factors and investigation of neonatal osteopenia. Clin Cases Miner Bone Metab 2013; 10 (02) 86-90
    PubMedSearch in Google Scholar
  • 6 Rehman MU, Narchi H. Metabolic bone disease in the preterm infant: current state and future directions. World J Methodol 2015; 5 (03) 115-121
    PubMedSearch in Google Scholar
  • 7 Vasikaran S, Eastell R, Bruyère O. , et al; IOF-IFCC Bone Marker Standards Working Group. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 2011; 22 (02) 391-420
    CrossrefPubMedSearch in Google Scholar
  • 8 Bachrach LK. Osteoporosis and measurement of bone mass in children and adolescents. Endocrinol Metab Clin North Am 2005; 34 (03) 521-535
    CrossrefPubMedSearch in Google Scholar
  • 9 Binkovitz LA, Henwood MJ. Pediatric DXA: technique and interpretation. Pediatr Radiol 2007; 37 (01) 21-31
    CrossrefPubMedSearch in Google Scholar
  • 10 Kalkwarf HJ, Abrams SA, DiMeglio LA, Koo WW, Specker BL, Weiler H. ; International Society for Clinial Densitometry. Bone densitometry in infants and young children: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17 (02) 243-257
    CrossrefPubMedSearch in Google Scholar
  • 11 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; (02) CD000390
    PubMedSearch in Google Scholar
  • 12 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 (09) 624-631
    CrossrefPubMedSearch in Google Scholar
  • 13 Schulz KF, Altman DG, Moher D. ; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152 (11) 726-732
    Search in Google Scholar
  • 14 Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr 1991; 119 (03) 417-423
    CrossrefPubMedSearch in Google Scholar
  • 15 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 (05) 1088-1092
    CrossrefPubMedSearch in Google Scholar
  • 16 Figueras-Aloy J, Álvarez-Domínguez E, Pérez-Fernández JM, Moretones-Suñol G, Vidal-Sicart S, Botet-Mussons F. Metabolic bone disease and bone mineral density in very preterm infants. J Pediatr 2014; 164 (03) 499-504
    CrossrefPubMedSearch in Google Scholar
  • 17 Rustico SE, Calabria AC, Garber SJ. Metabolic bone disease of prematurity. J Clin Transl Endocrinol 2014; 1 (03) 85-91
    PubMedSearch in Google Scholar
  • 18 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 (06) 432-437
    CrossrefPubMedSearch in Google Scholar
  • 19 Eliakim A, Nemet D, Friedland O, Dolfin T, Regev RH. Spontaneous activity in premature infants affects bone strength. J Perinatol 2002; 22 (08) 650-652
    CrossrefPubMedSearch in Google Scholar
  • 20 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 (02) 82-85
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Moyer-Mileur L, Luetkemeier M, Boomer L, Chan GM. Effect of physical activity on bone mineralization in premature infants. J Pediatr 1995; 127 (04) 620-625
    CrossrefPubMedSearch in Google Scholar
  • 22 Backström MC, Kouri T, Kuusela AL. , et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr 2000; 89 (07) 867-873
    CrossrefPubMedSearch in Google Scholar
  • 23 So K-W, Ng P-C. Treatment and prevention of neonatal osteopenia. Paediatr Child Health 2005; 15 (02) 106-113
    PubMedSearch in Google Scholar
  • 24 Hung YL, Chen PC, Jeng SF. , et al. Serial measurements of serum alkaline phosphatase for early prediction of osteopaenia in preterm infants. J Paediatr Child Health 2011; 47 (03) 134-139
    CrossrefPubMedSearch in Google Scholar
  • 25 Kelly A, Kovatch KJ, Garber SJ. Metabolic bone disease screening practices among U.S. neonatologists. Clin Pediatr (Phila) 2014; 53 (11) 1077-1083
    CrossrefPubMedSearch in Google Scholar
  • 26 Catache M, Leone CR. Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants. Acta Paediatr 2003; 92 (01) 76-80
    PubMedSearch in Google Scholar
  • 27 Schulzke SM, Kaempfen S, Trachsel D, Patole SK. Physical activity programs for promoting bone mineralization and growth in preterm infants. Cochrane Database Syst Rev 2014; (04) CD005387
    PubMedSearch in Google Scholar
  • 28 Kuschel CA, Harding JE. Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database Syst Rev 2004; (01) CD000343
    PubMedSearch in Google Scholar
  • 29 Aly H, Moustafa MF, Hassanein SM, Massaro AN, Amer HA, Patel K. Physical activity combined with massage improves bone mineralization in premature infants: a randomized trial. J Perinatol 2004; 24 (05) 305-309
    CrossrefPubMedSearch in Google Scholar
  • 30 Shiff Y, Eliakim A, Shainkin-Kestenbaum R, Arnon S, Lis M, Dolfin T. Measurements of bone turnover markers in premature infants. J Pediatr Endocrinol Metab 2001; 14 (04) 389-395
    PubMedSearch in Google Scholar
  • 31 Ryan S. Bone mineralization in preterm infants. Nutrition 1998; 14 (10) 745-747
    CrossrefPubMedSearch in Google Scholar