# Neonatal Multiple Bone Fractures: A Case Report of Hypophosphatasia

## TL;DR

A rare genetic bone disorder called hypophosphatasia caused severe symptoms in a newborn, highlighting the importance of early diagnosis and treatment.

## Contribution

This case report highlights the critical role of early diagnosis and enzyme replacement therapy in managing severe perinatal hypophosphatasia.

## Key findings

- The infant exhibited skeletal hypomineralization, respiratory distress, and undetectable ALP levels.
- Genetic analysis confirmed severe perinatal hypophosphatasia.
- ERT with asfotase alfa was initiated to manage the condition.

## Abstract

Hypophosphatasia (HPP) is a rare, inherited metabolic bone disorder characterized by mutation in the tissue nonspecific isoenzyme of alkaline phosphatase (ALP) (TNSALP). Perinatal HPP is the most severe type of HPP, primarily characterized by respiratory distress.

A 2-month-old female infant, born to consanguineous parents with intrauterine limb hypoplasia, sustained a clavicular fracture on day one. She was referred and admitted to the neonatal intensive care unit on day 20 of her life due to the development of seizures and respiratory distress. She presented with short limbs, skeletal hypomineralization, thoracic and pulmonary hypoplasia, hypercalcemia, and ALP levels below the limit of detection (LOD). Severe perinatal HPP was confirmed through genetic analysis. Consequently, she was treated with enzyme replacement therapy (ERT) using asfotase alfa.

Our case emphasized the need for proper diagnosis of severe perinatal HPP to initiate life-saving ERT after delivery. Cooperation between obstetricians and clinical genetics teams is essential to avoid delayed or misdiagnosis.