A Multidisciplinary and a Comprehensive Approach to Reducing Fragility Fractures in Preterm Infants

Area of Science:

• Neonatology
• Pediatric Orthopedics
• Neonatal Nutrition

Background:

• Preterm infants, especially those with very low or extremely low birth weight, are at risk for metabolic bone disease of prematurity (MBDP).
• MBDP leads to skeletal demineralization, decreased bone strength, and increased fracture risk, often exacerbated by secondary hyperparathyroidism.
• Fractures in these infants can occur from routine handling and are often asymptomatic, detected incidentally on radiographs.

Purpose of the Study:

• To implement and evaluate a comprehensive, multidisciplinary Neonatal Bone Health Programme (NBHP).
• The primary goal was to reduce fragility fractures in high-risk neonates.
• Key strategies included optimizing enteral and parenteral nutrition, maintaining a specific calcium-to-phosphate ratio, biochemical monitoring, and safe infant handling.

Main Methods:

• A Neonatal Bone Health Programme (NBHP) was instituted in 2015.
• The program focused on optimizing nutrition (calcium-to-phosphate ratio ≥1.3:1), biochemical monitoring, and safe handling practices.
• High-risk infants underwent regular radiographic monitoring.

Main Results:

• Following the implementation of the NBHP, the incidence of bone fractures in at-risk neonates decreased from 12.5% to zero.
• This reduction was observed over an 18-month period after the program's initiation.
• The program successfully minimized fragility fractures without compromising essential care practices like physiotherapy and skin-to-skin contact.

Conclusions:

• A multidisciplinary Neonatal Bone Health Programme (NBHP) is highly effective in preventing fragility fractures in preterm infants.
• Optimizing nutritional support, particularly the calcium-to-phosphate ratio, and implementing safe handling protocols are crucial for bone health in high-risk neonates.
• The NBHP demonstrates a successful model for reducing bone complications in vulnerable preterm populations.