O2065: Reducing Metabolic Bone Disease of Prematurity in the Neonatal Intensive Care Unit: A Quality Improvement Initiative

Purpose/Objectives: Metabolic bone disease of prematurity (MBDP) refers to the reduction in bone mineral content of infants born prematurely and is associated with a variety of radiographic and biochemical changes that can adversely affect clinical outcomes. In 2023, the level III and IV NICUs at University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh and UPMC Magee-Womens Hospital noted an increase in incidentally found fractures in the extremely premature population. As a result, the NICUs developed a quality improvement initiative to decrease the rate of incidentally found fractures by 20% in infants born less than 29 0/7 weeks gestation by June 2024 and to maintain this change for one year.

Design/Methods: The project used Institute for Healthcare Improvement methodology. Demographics, radiographic findings, laboratory values, feeding trends, and physical therapy sessions were reviewed for patients born less than 29 0/7 weeks gestation between October 2021 and August 2023 to determine baseline trends. Three interventions were developed and implemented between September 2023 and March 2024: standardized fragile bone signs in at-risk patient rooms, a bone strengthening physical therapy protocol, and a clinical guideline for screening, diagnosis, and treatment of MBDP. The same data was prospectively collected for eligible patients after implementation of the interventions and is on-going. Control charts were created and are prospectively updated for all measures.

Results: 280 patients have been included in this initiative thus far (22 0/7 - 28 6/7 weeks gestation). The baseline fracture rate was 5.02 fractures per 1000 patient days. Since implementation of the improvement initiatives, the fracture rate decreased to 1.42 fractures per 1000 patient days, a 71% reduction. There has been no significant change in laboratory values, feeding trends, or time to first physical therapy session.

Conclusion/Discussion: The incidentally found fracture rate in patients born less than 29 0/7 weeks gestation decreased during the time new bone health interventions were implemented. However, this project is on-going and there is still significant work to be done to continue to decrease these rates and improve the bone health of our smallest patients.