Dec. 6, 2007 When a child is born premature -- and more than one in ten infants in the U.S. is -- its future is already compromised. One of the common problems associated with premature births is "brittle bones," or osteopenia of prematurity (OOP). It can cause bone fractures and rickets in the infant, and osteoporosis later in life.
Tel Aviv University pediatric physicians are championing a training program that aims to make preemies' bones stronger. Dr. Dan Nemet and his partner Dr. Alon Eliakim, both associate professors of the Sackler School of Medicine at Tel Aviv University, have developed a proven protocol to prevent OPP.
Says co-researcher Dr. Dan Nemet, "About 12% of all births in the United States today are premature. It's unfortunate because it's in the last trimester when bones grow the most. More than 30% of preemies born before 30 weeks have some degree of OOP, but won't have any physical symptoms. It's critical to treat it before any symptoms are found."
In the last trimester of pregnancy, mothers transfer large amounts of calcium and phosphorus to the rapidly growing baby. It is also the time when babies exercise acquire muscle and strengthen bones in the womb. And when a child is born early, its physical activity is limited in the incubator. All of these factors contribute to OPP.
The researchers have shown that gentle exercises performed five times a day on the wrist, elbow, shoulder, ankle, knee, and hip joints (approximately 10 minutes for each session), and administered five times per week for four weeks, improved bone strength in preemies as measured using bone ultrasound. Daily interactive periods of holding and stroking the infant also influences bone growth and development, they conclude.
"We've had positive and encouraging results," says Dr. Nemet. "The preemies are definitely gaining more bone mass, their bones are growing stronger and subsequently the babies are gaining more weight. We can assume it means that the preemies are healthier and happier."
As part of a biannual course they teach, the physicians will demonstrate the benefits of their research during, "The Practitioners Guide to Pediatric Exercise," at the University of California-Irvine this January. The course is aimed at an international group of pediatric physicians, physiologists, trainers and teachers.
The intervention program involves extension and flexion exercises on preemies' arms and legs, and its efficacy has been reported in the Journal of Perinatology, Pediatrics, and the International Journal of Sports Medicine. Recently the duo presented current research at the 24th "Pediatric Work Physiology Meeting, Children and Exercise," in Tallinn, Estonia.
The National Institute of Health (NIH) has given a vote of confidence in the research by funding the physicians (together with a group led by Prof. Dan M. Cooper from the University of California-Irvine) to conduct a four-and-a-half year study of bone strength and exercise in preemies.
Mechanical strain is known to be a powerful stimulator of bone formation and growth. However, until now, no standard intervention program has been delivered. Normally, doctors attempt to treat the condition through calcium and phosphorus supplements, added to breast milk or IV fluids. But this treatment has not been found to be lead to optimization of bone strength, says Dr. Nemet, who is a specialist in pediatric health and who runs together with Dr. Eliakim a center in this field in Israel.
"Preemies have a disease which is manifested by fractures. We thought that if exercise works for strengthening the bones of older children and adults, then there's no reason why it can't work for preemies," says Dr. Nemet.
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