Growth and development in an extremely low birth weight infant with osteopenia of prematurity: a case report

  • Syifa Armenda Universitas Gadjah Mada
  • Tunjung Wibowo Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr.Sardjito Hospital, Yogyakarta, Central Java
  • Mei Neni Sitaresmi Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr.Sardjito Hospital, Yogyakarta, Central Java
Keywords: Extremely low birth weight, ELBW, osteopenia of prematurity, growth and development


Caring for extremely low birth weight (ELBW) infants remains a challenge in developing countries due to high morbidity and mortality rates. In Dr. Sardjito Hospital, Yogyakarta, the ELBW survival rate was 39.3%.1 Expected outcomes of these ELBW survivors are increased risk of mortality during the infant period and short term as well as long term complications.2 Osteopenia of prematurity is a comorbidity that can interfere with longterm growth and neurodevelopment.3

Osteopenia of prematurity is found in approximately 55% of babies with ELBW.4 Antenatal demineralization is aggravated by improper nutritional interventions during perinatal care and post-discharge care. This comorbidity is asymptomatic in the infant’s early life, but later contributes to linear growth failure, delayed teeth eruption, respiratory problems, and bone fractures in ELBW babies.3 Early detection and prompt management of osteopenia of prematurity are needed for all ELBW infants. Here we present a case of an ELBW infant with osteopenia of prematurity who we observed for 18 months. The child underwent multidisciplinary interventions for modifiable prognostic factors to support optimal achievement of growth and neurodevelopment.


1. Wibowo T, Haksari EL, Wandita S. Faktor prognostik kematian bayi berat lahir sangat rendah di rumah sakit rujukan tingkat tersier. Sari Pediatr.2012;13:401. DOI: 10.14238/sp13.6.2012.401-5.
2. Papageorgiou A, Pelausa E. Management and outcome of extremely low birth weight infants. J Pediatr Neonatal Individ Med. 2014;3:1–6. DOI:10.7363/030209
3. Harrison CM, Johnson K, McKechnie E. Osteopenia of prematurity: a national survey and review of practice. Acta Paediatr. 2008;97:407–13. DOI:10.1111/j.1651-2227.2007.00721.x
4. Lam HS, So KW, Ng PC. Osteopenia in neonates: a review. Hong Kong J Paediat. 2007;12:118–24.
5. Ikatan Dokter Anak Indonesia. Konsensus asuhan nutrisi pada bayi prematur. Cetakan pe. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2016.
6. Rigo J, Ziegler EE. Protein and energy requirements in infancy and childhood. 58thNestle Nutrition Workshop Series Pediatric Program. Ho Chi Minh, November 2005. ISBN: 978-3-8055-8081-6. e-ISBN: 978-3-318-01320-7. DOI: 10.1159/isbn.978-3-318-01320-7. p. 39.
7. Gunardi H, Kartasasmita CB, Hadinegoro SRS, Satari I, Oswari H, Pusponegoro HD, et al. Jadwal Imunisasi Anak Usia 0 - 18 tahun Rekomendasi Ikatan Dokter Anak Indonesia 2017. Sari Pediatr. 2017;18:417–22. DOI:10.14238/sp18.5.2017.417-22
8. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan, Departemen Kesehatan RI. Pedoman teknis penilaian rumah sehat. Cetakan Kedua. Jakarta; Depkes RI; 2007. p. 7.
9. Rehman MU, Narchi H. Metabolic bone disease in the preterm infant: current state and future directions. World J Methodol. 2015;5:115-21. DOI:10.5662/wjm.v5.i3.115
10. Mills RJ, Davies MW. Enteral iron supplementation in preterm and low birth weight infants. Cochrane Database Syst Rev. 2012;3:CD005095. DOI: 10.1002/14651858.CD005095.pub2.
11. March of Dimes, PMNCH, Save the Children, WHO. Born too soon: The global action report on preterm birth. Howson C, Kinney M, Lawn J, editors. Geneva: WHO; 2012. p. 79-84.
12. Zakria NM, Ismail TAT, Mansor WNAW, Sulaiman Z. Validation of infant and young child feeding questionnaire for the assessment of knowledge, attitudes and practices among child care providers: the IYCF-CCPQ. Int J Env Res Public Health. 2019;16:2147. DOI:10.3390/ijerph16122147.
13. Shavazi MA, Hajataghaiee SS, Sadeghian H, Shadkam M, Askarishahi M. Perceived benefits and barriers of mothers with premature infant to kangaroo mother care. Int J Pediatr.2019;7:9237–48. DOI:10.22038/ijp.2018.35249.3096
14. LaHood A, Bryant CA. Outpatient care of the premature infant. Am Fam Physician. 2007;76:1159-64. PMID: 17990838.
15. Manousaki D, Rauch F, Chabot G, Dubois J, Fiscaletti M, Alos N. Pediatric data for dual X-ray absorptiometric measures of normal lumbar bone mineral density in children under 5 years of age using the lunar prodigy densitometer. 2016;16:247–55. PMID: 27609039
16. Wells JCK, Davies PSW, Fewtrell MS, Cole TJ. Body composition reference charts for UK infants and children aged 6 weeks to 5 years based on measurement of total body water by isotope dilution. Eur J Clin Nutr. 2020;74:141–8. DOI:10.1038/s41430-019-0409-x
17. Jordan IM, Robert A, Francart J, Sann L, Putet G. Growth in extremely low birth weight infants up to three years. Biol Neonate. 2005;88:57–65. DOI:10.1159/000084701
18. Hack M, Schluchter M, Margevicius S, Andreias L, Taylor HG, Cuttler L. Trajectory and correlates of growth of extremely-low-birth-weight adolescents. Pediatr Res. 2014;75:358–66. DOI:10.1038/pr.2013.209
19. Ikatan Dokter Anak Indonesia. Perawakan pendek pada anak dan remaja di Indonesia. Batubara JR, Tjahjono HA, Aditiawati, editors. Jakarta:Badan Penerbit Ikatan Dokter Anak Indonesia; 2017. p.2-4.
20. Ogechi AA, William O, Fidelia BT. Hindmilk and weight gain in preterm very low-birthweight infants. Pediatr Int. 2007;49:156–60. DOI:10.1111/j.1442-200X.2007.02336.x
21. Elisabeth R, Elke G, Vera N, Maria G, Michaela H, Ursula K. Readmission of preterm infants less than 32 weeks gestation into early childhood: does gender difference still play a role?. Glob Pediatr Health. 2014;11:1-6. DOI:10.1177/2333794X14549621.
How to Cite
Armenda S, Wibowo T, Sitaresmi M. Growth and development in an extremely low birth weight infant with osteopenia of prematurity: a case report. PI [Internet]. 4Mar.2022 [cited 8Dec.2023];62(2):143-. Available from:
Case Report
Received 2020-07-04
Accepted 2022-03-04
Published 2022-03-04