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  • Quality Improvement Article
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Metabolic bone disease of prematurity screening and individualized enteral mineral supplementation in high-risk neonates: a quality improvement initiative

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

Prompted by an alarmingly low screening rate for metabolic bone disease of prematurity (MBDP), we aimed to increase MBDP screening with serum calcium, phosphorous, and alkaline phosphatase at four to six weeks of life in infants born at <1500 g and <32 gestational weeks from a baseline of 27.37% to 90% within one year.

Study design

We used the Institute for Healthcare Improvement’s Model for Improvement as a framework. A key driver diagram informed the interventions which were carried out through four Plan-Do-Study-Act cycles.

Results

There were 129 and 130 neonates in the pre-intervention baseline group and post-intervention MBDP bundle group, respectively. MBDP bundled primary screening rates increased from 27.37% to 95.56% (p < 0.001). Furthermore, 20% of infants had an individualized change in their enteral mineral supplementation after the initiative.

Conclusions

An interdisciplinary team-based quality improvement approach was effective in altering clinical practice to improve screening and subsequent treatment for MBDP.

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Fig. 1: Algorithm for MBDP primary and secondary screening.
Fig. 2: Annotated run chart of bundled primary tier screening rate.
Fig. 3

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Acknowledgements

We would like to acknowledge the significant assistance of physicians, advanced practice providers, nurses, and dietitians in the successful execution and maintenance of this initiative. We would also like to thank Elisa Sarmiento for providing statistical support.

Funding

This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute, in part by Grant Number UL1TR002529 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Priya V. Creed, Katie A. Huff, Linda A. DiMeglio & Beatrice M. Stefanescu

  2. Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

    Katie A. Huff, Kate Beard, Linda A. DiMeglio & Beatrice M. Stefanescu

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  1. Priya V. Creed
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Contributions

All authors were all involved int eh conceptualization of this study and in implementation of the quality improvement initiative. PC was responsible for collecting data through chart review. PC, KH, and BS were responsible for data analysis. PC drafted the initial manuscript. All authors were involved in reviewing and editing the manuscript. All authors agree to be accountable for all aspects of the work and final approval of the version to be published.

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Correspondence to Beatrice M. Stefanescu.

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Creed, P.V., Huff, K.A., Beard, K. et al. Metabolic bone disease of prematurity screening and individualized enteral mineral supplementation in high-risk neonates: a quality improvement initiative. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01892-9

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  • DOI: https://doi.org/10.1038/s41372-024-01892-9

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