Neonatal history must be taken in ex-preterms with fractures

By Piriya Mahendra, medwireNews Reporter

Researchers say that a neonatal history must be taken in all ex-preterm infants with rib fractures.

The recommendations come from Syed Ahmed (Royal Hospital for Sick Children, Glasgow, UK) and team, who found evidence of rib fractures in approximately 2% of the 1446 preterm infants in their study who had chest radiographs at a median age of 14 weeks.

Of the 62 fractures sustained by these infants, 27 (36%) were sited posteriorly, and 15 (53%) of these children were diagnosed with osteopathy of prematurity.

As reported in Pediatrics, classic risk factors for rib fracture including conjugated hyperbilirubinemia, diuretics, low calcium/phosphate levels, chronic lung disease, and high alkaline phosphatase levels were present in 23 (88%) of 26 infants.

A full skeletal survey was performed in eight (31%) of 26 participants. The authors note that investigations for nonaccidental injury occurred in four (15%) of 26 cases.

The analysis included 3318 infants who were born at less than 37 weeks' gestation and admitted before 2011 to three regional neonatal units. The chest radiographs that were performed in these infants were undertaken to investigate respiratory tract symptoms (38%), as part of an investigation of sepsis (27%), to confirm the position of an endotracheal tube, nasogastric tube, or central line (23%), and to investigate abdominal symptoms (12%).

"The prevalence of rib fractures in a group of ex-term preterm infants managed in contemporary tertiary neonatal centers is at approximately 2%, and the peak timing for their diagnosis coincides with that for osteopathy of prematurity," remark Ahmed and team.

"In these infants, rib fractures are often multiple and located posteriorly," they add. "Obtaining a careful history that investigates the neonatal course is critical in the evaluation of the ex-preterm infant with a coincidental finding of rib fractures."

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