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A Quality Improvement Project to Decrease Fractures Secondary to Metabolic Bone Disease of Prematurity
Nicole M Rau1, Lisa J Monagle2, Ashley M Fischer1
1From the Division of Neonatology, Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Ill.
Insights
A quality improvement initiative reduced fractures in premature infants by improving mineral intake compliance. This intervention significantly lowered fracture rates, enhancing care for extremely low birthweight infants.
Area of Science:
- Neonatal Medicine
- Pediatric Bone Health
- Quality Improvement Science
Background:
- Osteopenia of prematurity affects up to 54% of extremely low birthweight infants.
- Baseline fracture incidence in the neonatal intensive care unit was 13%.
- Poor compliance with calcium, calcium:phosphorus ratio, and Vitamin D intakes was noted.
Purpose of the Study:
- To implement and evaluate a quality improvement guideline for osteopenia of prematurity.
- To decrease fracture rates and improve mineral intake compliance in premature infants.
- To assess the impact of a multidisciplinary screening guideline.
Main Methods:
- A multidisciplinary team utilized four Plan-Do-Study-Act cycles.
- Guideline addressed staff education, Vitamin D screening, and calcitriol incorporation.
- 150 premature infants were screened for mineral intake, lab abnormalities, and fractures.
Main Results:
- Fracture incidence decreased from 13% to 5.3%.
- Compliance with calcium, calcium:phosphorus ratio, and Vitamin D improved.
- Infants born after guideline implementation were 4.8 times less likely to fracture.
Conclusions:
- Quality improvement methodology effectively reduced fractures in osteopenia of prematurity.
- The implemented guideline improved compliance with essential mineral intakes.
- This initiative enhanced patient outcomes for premature infants at risk.
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.
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