6509 Neonatal hospital acquired fractures: a tertiary NICU experience

<h3>Objectives</h3> Newborn services noted an increase in the number of incident forms submitted, related to infants on NICU identified as having a fracture. Our aim was to quantify the size of the problem and identify those infants at risk, with a view to exploring how fractures could be prevented. <h3>Methods</h3> Over an 18-month period we reviewed all incident forms and Badger discharge diagnoses to identify hospital acquired fractures. We did not include clavicular fractures relating to birth injury. <h3>Results</h3> From 1/1/2022 to 30/6/23 there were 1639 infants admitted to the tertiary NICU. Of these, we identified 17 infants with hospital acquired fractures, approximately 1%. 7 infants were found to have one fracture, 3 had two fractures and 7 infants had three or more. Femoral fractures were the most common type of fracture (7 infants), followed by skull (5), radius or ulna (4), tibia or fibula (3), humerus (2) and rib fractures (3). There were two peaks in the birth gestations of these infants. 35.3% were born at less than 28 weeks’ gestation, and 41.2% were born at 36 week’s or more. 41% had a birth weight less than 1.5kg and 59% had a birth weight above 1.5kg. Medical risk factors, in order of most prevalent, included metabolic bone disease (MBD) of prematurity, arthrogryposis/contractures, congenital myopathy, osteogenesis imperfecta and myelomeningocele. As part of this analysis, we reviewed compliance with the trust’s MBD of prematurity guideline as a snapshot across the trust, this being the first time practise had been audited across three sites. In those infants who sustained a fracture, compliance was poor, but a general snapshot of at risk infants demonstrated good compliance. In 44% of cases, there were known social concerns, and 68.8% of cases had some form of safeguarding review. <h3>Conclusion</h3> From this review, we concluded that hospital acquired fractures on the NICU were not isolated to those infants born at less than 28 week’s gestation or with a birth weight less than 1.5kg. There are several medical conditions that increase the risk of sustaining a fracture whilst on the NICU. There are also safeguarding concerns to be considered. Subsequently, we have developed a Standard Operating Procedure (SOP) that at identifies at risk infants in three tiers of severity and outlines agreed actions to prevent fractures. The SOP also includes guidance on early detection, investigation of underlying cause and management of fractures, along with consideration of the need for safeguarding review.