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

Publisher: Nature Publishing Group Country of Publication: United States NLM ID: 8501884 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-5543 (Electronic) Linking ISSN: 07438346 NLM ISO Abbreviation: J Perinatol Subsets: MEDLINE

Publication: 2001- : New York, NY : Nature Publishing Group
Original Publication: [Philadelphia, Pa. : W.B. Saunders, c1984-

Quality Improvement* ; Bone Diseases, Metabolic*/diagnosis ; Bone Diseases, Metabolic*/prevention & control ; Neonatal Screening*/methods ; Infant, Premature* ; Infant, Premature, Diseases*/prevention & control ; Infant, Premature, Diseases*/diagnosis ; Calcium*/blood ; Calcium*/administration & dosage; Humans ; Infant, Newborn ; Female ; Male ; Alkaline Phosphatase/blood ; Dietary Supplements ; Phosphorus/blood ; Enteral Nutrition ; Infant, Very Low Birth Weight

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.
(© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

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UL1TR002529 Indiana Clinical and Translational Sciences Institute (CTSI)

SY7Q814VUP (Calcium)
EC 3.1.3.1 (Alkaline Phosphatase)
27YLU75U4W (Phosphorus)

Date Created: 20240206 Date Completed: 20240907 Latest Revision: 20240907

20240908

10.1038/s41372-024-01892-9

38321167