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.
    • Use Neonatal, Pediatric Bone Health Order set
    • Consider Orthopedics consult for long bone fracture management
  • Bone health Team
  • Provides recommendations for care while patient meets screening criteria
Start primary screen by 1 month of age
  • Primary Screening
    • TPN panel or
    • BMP, Phosphorus, Alkaline Phosphatase
    • Clinically indicated X-rays
Abnormal
Normal
Abnormal
Normal
Repeat primary screen every
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
Evidence
CHOP Programs