Metabolic bone disease screening practices among U.S. neonatologists.

Area of Science:

• Neonatology
• Pediatric Endocrinology
• Nutritional Science

Background:

• Preterm, low-birth-weight neonates are at high risk for developing metabolic bone disease (MBD).
• Current practices for MBD management in neonatal intensive care units (NICUs) lack standardization.
• Effective strategies for MBD prevention, recognition, and treatment are crucial for this vulnerable population.

Purpose of the Study:

• To survey current screening, diagnostic, and treatment practices for MBD in U.S. level IIIB/IIIC NICUs.
• To identify variations and inconsistencies in MBD management protocols.
• To inform the development of evidence-based guidelines for MBD care.

Main Methods:

• An anonymous 29-question online survey was distributed to members of the American Academy of Pediatrics Perinatal Section.
• The survey targeted neonatologists in level IIIB/IIIC NICUs across the United States.
• Responses from 338 neonatologists representing 246 NICUs were analyzed.

Main Results:

• 86% of surveyed NICUs reported screening for MBD, primarily based on gestational age (<26 to <36 weeks), birth weight, and duration of total parenteral nutrition.
• Diagnosis commonly relied on elevated alkaline phosphatase (>500 U/L), with 52% utilizing X-ray findings.
• Treatment frequently involved human milk fortification (83%), vitamin D (67%), calcium (65%), and phosphorus (65%) supplementation.

Conclusions:

• Widespread awareness of MBD exists in U.S. NICUs, but significant variability in definition, screening criteria, and treatment approaches is evident.
• The findings underscore a lack of consensus in MBD management, necessitating further research.
• Optimized, standardized strategies are required for the effective prevention, recognition, and management of MBD in preterm neonates.