Endocrine Abstracts

Premature infants are at significant risk of reduced bone mineral content and osteopenia. Inadequate phosphate and calcium uptake in-utero followed by poor postnatal intake in the presence of high growth velocity leads to metabolic bone disease in premature babies. It is not due to vitamin D or parathyroid hormone deficiency.

There is no national or international consensus on how to prevent or manage this condition leading to varied practice across the different units in the UK.

We conducted an audit at local neonatal unit to see if current available guidance was helpful for clinicians in making right decisions in preventing this common neonatal condition. Local neonatal guideline was used as a standard as there was no national standard.

We recruited 29 babies with birth weight <1.5 kg, admitted to neonatal unit between July 2007 and July 2009. Data was collected on a structured proforma by retrospective review of case notes and was analysed without using statistical tests.

Of the 29 babies, 13 were excluded because of death or incomplete data. In 6/16 babies, oral phosphate treatment was indicated, however in only 4 babies treatment was started (66%). In 10 babies treatment was not indicated but 1 baby still was started on treatment. Five babies in whom oral phosphate treatment was started, the starting dose was appropriate however in 2/5 the dose of oral phosphate was not increased appropriately when indicated. One baby had possible Rickets but X-ray wrist was not taken and Rickets was not investigated or treated.

This audit highlighted two main issues; one, lack of uniformity in managing metabolic bone disease in premature babies and two, inadequate details in the guideline leading to difficult interpretations and decision making.

There is a need for standardisation of the guidance at national level so as to avoid confusion and help clinicians making uniform decisions.