A Quality Improvement Project to Decrease Fractures Secondary to Metabolic Bone Disease of Prematurity
Pediatr Qual Saf. 2024 Jul 29;9(4):e750. doi: 10.1097/pq9.0000000000000750. eCollection 2024 Jul-Aug.
Nicole M Rau 1, Lisa J Monagle 2, Ashley M Fischer 1
Introduction: Osteopenia of prematurity is common in the neonatal intensive care unit, with an incidence of up to 54% in extremely low birthweight infants. The baseline fracture rate in our level IV midwestern neonatal intensive care unit was 13%, with poor compliance with recommended intakes of calcium, calcium:phosphorus ratio, and Vitamin D.
Methods: A multidisciplinary team implemented a screening guideline through four Plan-Do-Study-Act cycles, which addressed staff education, vitamin D screening, and incorporation of calcitriol. In total, 150 patients born between October 1, 2019 and April 30, 2023 were screened for mineral intakes, laboratory abnormalities, and the development of fractures or osteopenia.
Results: The incidence of fractures decreased from 13% to 5.3%. Compliance with mineral intakes improved for calcium, calcium: phosphorus ratio, and Vitamin D. Infants born after the guideline were 4.8 times less likely to develop fractures.
Conclusion: Quality improvement methodology successfully decreased the rate of fractures due to osteopenia of prematurity and increased compliance with recommended mineral intakes.
Even fewer fractures if gave 800 IU to preemie
- Preterm birth rate increased in US but decreased in Finland (high Vitamin D) - Jan 2024
- Preterm birth and low Vitamin D - many studies
- Supplement preterm infants with vitamin D if less than 80 ng – RCT Sept 2021
- Preemies should have vitamin D supplements – reaching an agreement – April 2021
- Preemies still have low vitamin D at age 6 – Oct 2019
They appear to need more vitamin D for the rest of their lives