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Effect on metabolic bone disease markers in the neonatal intensive care unit with implementation of a practice guideline

Journal of Perinatology volume 40, pages 1267–1272 (2020)Cite this article

Subjects

Abstract

Objectives

To determine the effect of implementing a 2015 policy for the screening, prevention, and management of metabolic bone disease for very low birth weight (VLBW) infants in two Level IV NICUs.

Study design

Retrospective cohort study of VLBW infants in the 2 years prior to (2013–2014) and after (2016–2017) policy implementation.

Results

We identified 316 VLBW infants in 2013–2014 and 292 in 2016–2017 who met study criteria. After policy implementation, vitamin D supplementation began earlier (20.1 ± 15.5 days vs 30.2 ± 20.1 days, p < 0.0005), the percentage of infants with alkaline phosphatase obtained increased (89.7% vs 76.3%, p < 0.0005), while the percentage of infants with alkaline phosphatase >800 IU/L (11.7 vs 4.5%, p = 0.0001) and phosphorous <4 mg/dL (14.2% vs 7.9%, p = 0.014) fell significantly.

Conclusions

After policy implementation, vitamin D supplementation began significantly earlier and the rate of detecting abnormal biochemical markers of metabolic bone disease decreased significantly.

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Acknowledgements

We thank Dr. Reese Clark, Dr. Veeral Tolia, and Dr. Blanca Molina for their critical review of this manuscript. We thank our quality improvement team for support of this protocol after initiation.

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Authors and Affiliations

  1. Baylor College of Medicine, San Antonio, TX, USA

    Elizabeth Marie Sabroske, Cheryl Leah Motta, Maria Rodriguez Pierce & Kaashif Aqeeb Ahmad

  2. University of Texas Health Sciences Center, San Antonio, TX, USA

    Davis Harrison Payne

  3. Central Ohio Newborn Medicine, Columbus, OH, USA

    Christina Nicole Stine

  4. Pediatrix Medical Group of San Antonio, San Antonio, TX, USA

    Charmaine Marie Kathen, Heather Marie Sollohub, Katy Leanne Kohlleppel, Pamela Louise Lorbieski, Jennifer Elizabeth Carney, Cheryl Leah Motta, Maria Rodriguez Pierce & Kaashif Aqeeb Ahmad

  5. The Center for Research, Education, Quality, and Safety, MEDNAX National Medical Group, Sunrise, FL, USA

    Kaashif Aqeeb Ahmad

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  1. Elizabeth Marie Sabroske
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Correspondence to Kaashif Aqeeb Ahmad.

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All authors have indicated that they have no potential conflict of interest to disclose. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA or any of its affiliated entities.

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Sabroske, E.M., Payne, D.H., Stine, C.N. et al. Effect on metabolic bone disease markers in the neonatal intensive care unit with implementation of a practice guideline. J Perinatol 40, 1267–1272 (2020). https://doi.org/10.1038/s41372-020-0693-2

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