A variety of skeletal abnormalities can be seen in the newborn period as the result of a myriad of underlying disease processes that affect bone development. These include metabolic, genetic, endocrine, and infectious etiologies. The metabolic differential is vast, but most common are the bone changes associated with prematurity. In addition, fractures either due to underlying bony insufficiency or due to trauma can be seen.

Radiology plays an important role in the investigation of all skeletal abnormalities in the newborn period. The primary imaging modality is x-ray. CT and MRI may be indicated in special circumstances. Ultrasound is a very useful supplementary imaging modality.

Metabolic bone disease

Osteopenia of prematurity

Poor mineral stores in the preterm infant result from the loss of the normal third trimester accretion of minerals. This may then be compounded by increased mineral demands and decreased activity and tone in the sick preterm. Finally, if there is inadequate vitamin D supplementation, further demineralization ensues. Collectively, this may result in metabolic bone disease of the preterm, known as osteopenia of prematurity.

The first radiological signs are usually seen between 6 and 12 weeks of post-natal life. Biochemical investigations, such as serum calcium and alkaline phosphatase, correlate poorly with bone mineralization. This is often noted on x-rays performed for other reasons, most oft en a CXR. Hence, it is important to ensure that all images for preterms include an interpretation of the bones.