Inpatient Clinical Pathway for Screening Infants
at Risk for Fractures
- Primary Bone Disorder
- Osteogenesis Imperfecta
- Osteopetrosis
- Rickets
- History of fracture
- Patient Characteristics
- BW < 1000 grams
- GA < 28 weeks
- SGA/IUGR
- TPN > 1 month
- Preterm infants on unfortified breast milk or term formula
- Malabsorption
- High Risk Medications
- Osteopenia
Fragile Bones Prevention
- Front Line Clinician
- Order Bone Health Consult:
- Page Endo Bone Cnslt
Mon - Fri, 8 a.m. - 5 p.m.
- Page Endo Bone Cnslt
- Use Neonatal, Pediatric Bone Health Order set
- Consider Orthopedics consult for long bone fracture management
- Order Bone Health Consult:
- Bedside RN
- Post Fragile Bones prevention sign clearly visible per unit standard location. Download Fragile Bones Prevention Sign
- Bone Health Promotion Care Guidelines
- Bone health Team
- Provides recommendations for care while patient meets screening criteria
- Initiate the following if any risk:
Start primary screen by 1 month of age
- Primary Screening
- TPN panel or
- BMP, Phosphorus, Alkaline Phosphatase
- Clinically indicated X-rays
Abnormal
Normal
Abnormal
- Secondary Screening
- Parathyroid Hormone
- 25 OH Vitamin D level
- Urine Ca/Cr/Phos [UCa/Cr; Tubular Reabsorption of Phosphate (TRP)]
- Additional X-rays as clinically indicated
Normal
Repeat primary screen
every
2-4 weeks
2-4 weeks
Abnormal Primary Screen
- Consider stopping primary screening when patient
- Is 37 weeks corrected gestational age
- After 2-3 normal primary screens despite chronic
risk factor(s) - Consult Bone Health
as directed
Posted: January 2021
Revised: October 2021
Authors: T. Edwards, CRNP; A. Calabria, MD; U. Nawab, MD; D. Versaw-Barnes, DPT; L. Heimall, PCNS; M. Begany, RD; E. Paul, RD
Revised: October 2021
Authors: T. Edwards, CRNP; A. Calabria, MD; U. Nawab, MD; D. Versaw-Barnes, DPT; L. Heimall, PCNS; M. Begany, RD; E. Paul, RD
Evidence
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