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How common are rib fractures in extremely low birth weight preterm infants?
D Smurthwaite1, N B Wright, S Russell
1Department of Paediatrics, Saint Mary's Hospital for Women & Children, Hathersage Road, Manchester, UK.
Insights
Healing rib fractures were incidentally found in extremely low birth weight (ELBW) infants. This finding suggests considering non-accidental injury (NAI) in these vulnerable infants, even with respiratory illnesses.
Area of Science:
- Neonatal care
- Pediatric radiology
- Forensic pediatrics
Background:
- Incidental rib fractures noted on chest radiographs of ex-preterm infants with respiratory illnesses.
- Posterior rib fractures in infants are highly specific for non-accidental injury (NAI).
Purpose of the Study:
- To investigate the occurrence and implications of rib fractures in extremely low birth weight (ELBW) infants.
- To determine if rib fractures in ELBW infants warrant consideration of NAI.
Main Methods:
- Retrospective review of radiographs from ELBW infants (< or =1000 g) born between 22-33 weeks gestation.
- Infants were cared for in a tertiary neonatal intensive care unit (NICU) between 1998-2002 and survived at least 4 weeks.
Main Results:
- Rib fractures were identified in 7% (5/72) of the studied ELBW infants.
- None of the observed rib fractures involved posterior rib shafts.
- All infants with rib fractures in this cohort died during their NICU stay.
Conclusions:
- The presence of rib fractures in ex-ELBW infants should raise suspicion for NAI.
- Further investigation into the etiology of rib fractures in this high-risk population is warranted.
Background:
This study was prompted by incidental finding of healing rib fractures on chest radiographs of ex-preterm born infants, who were admitted to hospital with acute respiratory illnesses within a few weeks of discharge from the neonatal intensive care unit (NICU). Rib fractures in infants, particularly those situated posteriorly, are considered to be specific for non-accidental injury (NAI).
Methods:
Retrospective examination of radiographs of extremely low birth weight (ELBW) infants (< or =1000 g) with a gestation range of 22 of 33 weeks, cared for at a tertiary NICU, between 1998 and 2002, and who had survived > or =4 weeks.
Results:
Five out of 72 (7%) infants studied had radiologically apparent rib fractures. None involved posterior rib shafts. All infants with rib fractures died on the NICU.
Conclusions:
The possibility of NAI should be considered in ex-ELBW infants found to have rib fractures.
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