Risk factors associated with the development of metabolic bone disease in infants admitted to the pediatric intensive care unit

OBJECTIVE: Critically ill infants in the intensive care unit (ICU) are at an increased risk of metabolic bone disease (MBD). Our objective was to identify the prevalence and independent risk factors for MBD in infants admitted to the ICU. STUDY DESIGN: A retrospective analysis of 208 infants meeting the inclusion criteria of age <12 months and ICU admission for >4 weeks to the University Children's Hospital Zurich between May 2015 and May 2021 was conducted. MBD was identified based on radiographic evidence of osteopenia and/or fractures. Multivariable logistic regression analysis was performed to assess the independent risk factors of MBD. RESULTS: Of the cohort studied, 101 patients (48.6%) had radiological evidence of MBD, including 8 cases (7.9%) with at least one fracture. Infants with MBD demonstrated a significantly higher mortality rate compared to those without MBD (18.8% vs 2.8%; p < 0.001). Multivariate logistic regression analysis revealed that exposure to parenteral nutrition (adjusted OR 2.81, 95% CI, 1.32-5.98, p = 0.007) and corticosteroids (adjusted OR 2.96, 95% CI, 1.37-6.37, p = 0.006) were independently associated with MBD. CONCLUSION: Our findings demonstrate that MBD is a common occurrence among critically ill infants in the ICU. Exposure to parenteral nutrition and corticosteroids increases the risk of MBD development, highlighting the need for targeted screening and preventive interventions in this at-risk population.