Quantitative ultrasound assessment of bone tissue in premature newborn twins





premature infants, twins, ultrasonic densitometry


Multiple pregnancy is associated with a high risk premature newborn twins (PNT) birth and the formation of low bone mass. Determining the state of bone tissue (BT) after birth is important for understanding the dynamics of its changes in the PNTs’ growth.

Aim: to conduct and analyze the results of quantitative ultrasound assessment of BT in PNT.

Materials and methods. In the early neonatal age, 24 pairs of twins and 39 children from singleton pregnancies (SP) born at gestational age (GA) of 30–36 weeks were examined. Pair of twins with a difference in body weight of 5% or more were involved. BT status was determined with an ultrasonic densitometer “Sunlight Omnisense 9000”, measuring SOS, m/s.

Results. In GA up to 34 weeks SOS of BT in both twins did not differ from each other or from newborns from SP of the corresponding GA. In PNT, from 34 weeks of gestation and more, SOS increased (P < 0.05) in siblings with lower body weight compared to bigger one – 2925 (2887; 3036) m/s and 2866 (2801; 2895) m/s, respectively. According to correlations, the body weight of PNT was not determined as a significant factor influencing the state of BT. SOS in PNT had a weak positive correlation (R = 0.29, P < 0.05) with their GA in contrast to the strong direct correlation (R = 0.78, P < 0.05) in newborns from SP.

Among the factors influencing the state of BT according to SOS in PNT, the inverse correlations with the factor of increasing the number of pregnancies (R = -0.59, P < 0.05) and with birth from monochorionic multiple pregnancies (R = -0.57, P < 0.05) were determined.

Conclusions. SOS in children born in GA of 34 weeks and older was 2925 (2887; 3036) m/s in PNT with lower body weight in pairs. This value was higher (P < 0.05) than in bigger siblings and PNT born in GA less than 34 weeks. SOS in PNT had a weak correlation (P < 0.05) with their GA in contrast to children born in the same GA from SP and had no correlation with the body weight of twins. The average correlation (P < 0.05) between low SOS in PNT and the number of previous pregnancies, as well as with birth from monochorionic multiple pregnancies.

Author Biographies

A. Yu. Tsymbal, Zaporizhzhia State Medical University, Ukraine

PhD student of the Department of Pediatric Diseases

Yu. V. Kotlova, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Pediatric Diseases


Martin, J. A., Hamilton, B. E., Osterman, M., & Driscoll, A. K. (2019). Births: Final Data for 2018. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 68(13), 1-47.

Tkachenko, A. (2019). Porivnialnyi analiz perebihu vahitnosti, polohiv i stanu novonarodzhenykh pry dviiniakh z monokhorialnym typom platsentatsii [Comparative analysis of the pregnancy, labour and condition of newborn twins with monochorionic type of placentation]. Zdorov'e zhenshchiny - Health of woman, (4), 46-49. https://doi.org/10.15574/hw.2019.140.46

Weghofer, A., Klein, K., Stammler-Safar, M., Worda, C., Barad, D., Husslein, P., & Gleicher, N. (2010). The impact of fetal gender on prematurity in dichorionic twin gestations after in vitro fertilization. Reproductive Biology and Endocrinology, 8(1), 57. https://doi.org/10.1186/1477-7827-8-57

Puccio, G., Giuffré, M., Piccione, M., Piro, E., Rinaudo, G., & Corsello, G. (2013). Intrauterine growth restriction and congenital malformations: a retrospective epidemiological study. Italian Journal of Pediatrics, 39(1), 23. https://doi.org/10.1186/1824-7288-39-23

Tong, L., Gopal-Kothandapani, J., & Offiah, A. (2018). Feasibility of quantitative ultrasonography for the detection of metabolic bone disease in preterm infants - systematic review. Pediatric Radiology, 48(11), 1537-1549. https://doi.org/10.1007/s00247-018-4161-5

Mihatsch, W., Thome, U., & Saenz de Pipaon, M. (2021). Update on Calcium and Phosphorus Requirements of Preterm Infants and Recommendations for Enteral Mineral Intake. Nutrients, 13(5), 1470. https://doi.org/10.3390/nu13051470

Gleason, J. L., Yeung, E., Sundaram, R., Mendola, P., Bell, E. M., Vafai, Y., Robinson, S. L., Putnick, D. L., & Grantz, K. L. (2021). Developmental outcomes in small-for-gestational age twins using a singleton vs twin birthweight reference. American journal of obstetrics & gynecology MFM, 3(6), 100465. https://doi.org/10.1016/j.ajogmf.2021.100465

Grantz, K. L., Grewal, J., Albert, P. S., Wapner, R., D'Alton, M. E., Sciscione, A., Grobman, W. A., Wing, D. A., Owen, J., Newman, R. B., Chien, E. K., Gore-Langton, R. E., Kim, S., Zhang, C., Buck Louis, G. M., & Hediger, M. L. (2016). Dichorionic twin trajectories: the NICHD Fetal Growth Studies. American journal of obstetrics and gynecology, 215(2), 221.e1-221.e16. https://doi.org/10.1016/j.ajog.2016.04.044

Fenton, T. R., & Kim, J. H. (2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC pediatrics, 13, 59. https://doi.org/10.1186/1471-2431-13-59

Borg, S. A., Buckley, H., Owen, R., Marin, A. C., Lu, Y., Eyles, D., Lacroix, D., Reilly, G. C., Skerry, T. M., & Bishop, N. J. (2018). Early life vitamin D depletion alters the postnatal response to skeletal loading in growing and mature bone. PloS one, 13(1), e0190675. https://doi.org/10.1371/journal.pone.0190675

Fox, N., Rebarber, A., Klauser, C., Roman, A., & Saltzman, D. (2010). Intrauterine Growth Restriction in Twin Pregnancies: Incidence and Associated Risk Factors. American Journal Of Perinatology, 28(04), 267-272. https://doi.org/10.1055/s-0030-1270116

Leombroni, M., Liberati, M., Fanfani, F., Pagani, G., Familiari, A., Buca, D., Manzoli, L., Scambia, G., Rizzo, G., & D'Antonio, F. (2017). Diagnostic accuracy of ultrasound in predicting birth-weight discordance in twin pregnancy: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology, 50(4), 442-450. https://doi.org/10.1002/uog.17348

Al-Agha, A. E., Kabli, Y. O., AlBeiruty, M. G., & Milyani, A. A. (2019). Determinants of bone mineral density through quantitative ultrasound screening of healthy children visiting ambulatory paediatric clinics. Saudi medical journal, 40(6), 560-567. https://doi.org/10.15537/smj.2019.6.24234

Kara, S., Güzoğlu, N., Göçer, E., Arıkan, F. I., Dilmen, U., & Dallar Bilge, Y. (2016). Evaluation of bone metabolism in newborn twins using quantitative ultrasound and biochemical parameters. The journal of maternal-fetal & neonatal medicine, 29(6), 944-948. https://doi.org/10.3109/14767058.2015.1025743

Fewtrell, M. S., Loh, K. L., Chomtho, S., Kennedy, K., Hawdon, J., & Khakoo, A. (2008). Quantitative ultrasound (QUS): a useful tool for monitoring bone health in preterm infants?. Acta paediatrica, 97(12), 1625-1630. https://doi.org/10.1111/j.1651-2227.2008.00992.x



How to Cite

Tsymbal AY, Kotlova YV. Quantitative ultrasound assessment of bone tissue in premature newborn twins. Pathologia [Internet]. 2022Apr.15 [cited 2024Apr.16];19(1):53-7. Available from: http://pat.zsmu.edu.ua/article/view/252562



Original research