Abstract
Introduction and Objectives:
We aimed to examine the demographic and clinical characteristics of children with Fragility Bone fractures (FF) in our pediatric intensive care unit (PICU) and to evaluate possible risk factors for FF.
Material and methods:
The medical records of patients hospitalized in the PICU in the previous five years were reviewed in terms of their demographic, anatomical, and therapeutic features.
Results:
Seven patients with a total of nine bone fractures were identified. During this period, 807 patients were admitted to the PICU (0.59 fracture cases / 1000 hospitalization days). The median patient age at the time of fracture definition was 5.29±2.82 years (range: 1.39 to 8.43 years). Four patients were diagnosed with congenital quadriplegic cerebral palsy (CP), one with quadriplegia after cerebral venous sinus thrombosis, one with meningomyelocele, and one with spinal muscular atrophy (SMA). Six patients were hospitalized for extended periods. The mean length of hospitalization in patients with bone fractures (73.92 days) was significantly higher than the length of stay of all patients (14.72 days) (p < 0.001). Bone fractures were detected between days two and 165 of admission. Bone fractures were in the humerus in one case and the femur in all others. No patients had a weight percentile <5% based on Turkish national data. Based on evaluation of weight for height, one patient had mild protein-energy malnutrition (PEM), one was overweight, one was obese, and the others were normal. All patients were also diagnosed with epilepsy, were fed by nasogastric tube, and experienced prolonged immobility.
Conclusions:
Patients hospitalized in the PICU are at risk for fragility fractures. Rapid evaluation and treatment in terms of fragility bone fractures should be initiated, particularly in the presence of clinical clues during the follow-up of patients with CP. Conditions that cause long-term immobility such as CP and SMA are the principal risk factors.
Keywords
Pediatric Intensive Care Units Bone fractures Cerebral Palsy Spinal Muscular Atrophies of Childhood
References
- 1. Organization WH. Guidelines for preclinical evaluation and clinical trials in osteoporosis. World Health Organization; 1998.
- 2. Xu Q, Pillai SM, Barsony J et al. SUN-371 Hyponatremia Correction Normalizes Bone Mineral Density and Bone Fragility in Rats. Journal of the Endocrine Society 2020; 4: SUN-371.
- 3. Patel M, Ayus JC, Moritz ML. Fragility fractures and reversible osteopaenia due to chronic hyponatraemia in an adolescent male. BMJ Case Reports CP 2019; 12: e229875.
- 4. Huh SY, Gordon CM. Fractures in hospitalized children. Metabolism 2013; 62: 315-325.
- 5. Krell RW, Girotti ME, Dimick JB. Extended length of stay after surgery: complications, inefficient practice, or sick patients? JAMA surgery 2014; 149: 815-820.
- 6. Cheng HH, Carmona F, McDavitt E et al. Fractures related to metabolic bone disease in children with congenital heart disease. Congenital heart disease 2016; 11: 80-86.
- 7. Society TPEaD. CHILD METRICS. In: 2020:
- 8. De Onis M. WHO child growth standards. Geneva: WHO 2006; 1Á336.
- 9. David Strauss RS, Jordan Brooks. New Growth Charts. In: 2020:
- 10. Krick J, Murphy-Miller P, Zeger S et al. Pattern of growth in children with cerebral palsy. Journal of the American Dietetic Association 1996; 96: 680-685.
- 11. Schonfeld-Warden N, Warden CH. Pediatric obesity: an overview of etiology and treatment. Pediatric Clinics of North America 1997; 44: 339-361.
- 12. Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 2011; 96: 1911-1930.
- 13. Pektaş MK, Koyuncu H, Kundak AA. Long bone fractures in neonatal intensive care units of Afyonkarahisar: Five-year’s experience. Turkish Journal of Obstetrics and Gynecology 2019; 16: 219.
- 14. Fortin K, Bertocci G, Nicholas JL et al. Long bone fracture characteristics in children with medical conditions linked to bone health. Child Abuse & Neglect 2020; 103: 104396.
- 15. Jesus AO, Stevenson RD. Optimizing Nutrition and Bone Health in Children with Cerebral Palsy. Physical Medicine and Rehabilitation Clinics 2020; 31: 25-37.
- 16. Henderson RC, Lark RK, Gurka MJ et al. Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics 2002; 110: e5-e5.
- 17. Rehberg M, Azim M, Martakis K et al. Bone microarchitecture assessed by Trabecular Bone Score is independent of mobility level or height in pediatric patients with cerebral palsy. J Bone Miner Res 2020.
- 18. Wasserman HM, Hornung LN, Stenger PJ et al. Low bone mineral density and fractures are highly prevalent in pediatric patients with spinal muscular atrophy regardless of disease severity. Neuromuscular Disorders 2017; 27: 331-337.
- 19. Faienza MF, D'Amato G, Chiarito M et al. Mechanisms involved in childhood obesity-related bone fragility. Frontiers in endocrinology 2019; 10: 269.
- 20. Mohamed N, Makaranka S, Cheema K et al. Bilateral acetabular fractures induced by an epileptic seizure in a paediatric patient: a unique case and its management. BMJ Case Reports CP 2019; 12: e230143.
- 21. Via MA, Gallagher EJ, Mechanick JI. Bone physiology and therapeutics in chronic critical illness. Annals of the New York Academy of Sciences 2010; 1211: 85-94.
- 22. Van den Berghe G, Van Roosbroeck D, Vanhove P et al. Bone turnover in prolonged critical illness: effect of vitamin D. The Journal of Clinical Endocrinology & Metabolism 2003; 88: 4623-4632.
- 23. Contreras JJ, Hiestand B, O’Neill JC et al. Vitamin D deficiency in children with fractures. Pediatric Emergency Care 2014; 30: 777-781.
- 24. Wesseling K, Bakkaloglu S, Salusky I. Chronic kidney disease mineral and bone disorder in children. Pediatr Nephrol 2008; 23: 195-207.
- 25. Bowles SA, Kurdy N, Davis AM et al. Serum osteocalcin, total and bone-specific alkaline phosphatase following isolated tibial shaft fracture. Annals of clinical biochemistry 1996; 33: 196-200.
- 26. Hirsh J, Warkentin TE, Shaughnessy SG et al. Heparin and low-molecular-weight heparin mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001; 119: 64S-94S.
- 27. Petrisko MA, Skoner JD, Skoner DP. Safety and efficacy of inhaled corticosteroids (ICS) in children with asthma. Journal of Asthma 2008; 45: 1-9.
- 28. Allen DB. Inhaled Corticosteroids and Endocrine Effects in Childhood. Endocrinology and Metabolism Clinics 2020; 49: 651-665.
- 29. Wagner K, Wagner S, Susi A et al. Prematurity does not increase early childhood fracture risk. The Journal of pediatrics 2019; 207: 148-153.
- 30. Mughal MZ. Fractures in children with cerebral palsy. Current osteoporosis reports 2014; 12: 313-318.
Abstract
Giriş ve Amaç:
Çocuk yoğun bakım ünitemizde (ÇYBÜ) Frajil Kemik kırığı (FF) olan çocukların demografik ve klinik özelliklerini incelemeyi ve FF için olası risk faktörlerini değerlendirmeyi amaçladık.
Araç ve yöntemler:
Son beş yıl içinde ÇYBB'de yatan hastaların tıbbi kayıtları demografik, anatomik ve terapötik özellikleri açısından gözden geçirildi.
Sonuçlar:
Toplam dokuz kemik kırığı olan yedi hasta belirlendi. Bu dönemde 807 hasta ÇYBB'ye kabul edilmişti (0,59 kırık vakası / 1000 hastanede kalış günü). Kırık tanımlandığı sırada ortalama hasta yaşı 5,29 ± 2,82 yıl (aralık: 1,39 ila 8,43 yıl) idi. Dört hasta konjenital kuadriplejik serebral palsi (SP), bir hasta serebral venöz sinüs trombozu sonrası kuadripleji, bir hasta ise meningomiyelosel ve bir hastaya spinal musküler atrofi (SMA) tanısı konmuştu. Altı hasta uzun süre yatmıştı. Kemik kırığı olan hastalarda ortalama hastanede kalış süresi (73.92 gün) tüm hastaların yatış süresinden (14,72 gün) anlamlı olarak daha yüksekti (p <0,001). Başvurunun ikinci ve 165. günleri arasında kemik kırıkları tespit edildi. Kemik kırıkları bir vakada humerusta, diğerlerinde femurdaydı. Türkiye ulusal verilerine göre hiçbir hastada ağırlık yüzdesi <% 5 değildi. Boy için kilo değerlendirmesine göre, bir hastada hafif protein-enerji malnütrisyonu(PEM) vardı, biri fazla kilolu, biri obezdi, diğerleri normaldi. Tüm hastalara ayrıca epilepsi teşhisi konmuş, nazogastrik tüple beslenmiş ve uzun süreli immobilite tespit edilmişti.
Sonuçlar:
ÇYBB'de hastaneye yatırılan hastalar kırılganlık kırıkları açısından risk altındadır. Özellikle SP'li hastaların takibinde klinik ipuçları varlığında kırılganlık kemik kırıkları açısından hızlı değerlendirme ve tedaviye başlanmalıdır. CP ve SMA gibi uzun süreli hareketsizliğe neden olan koşullar başlıca risk faktörleridir.
Keywords
Çocuk Yoğun Bakım Ünitesi Kemik kırıkları Serebral Palsi Çocukluk çağı Spinal Müsküler Atrofileri
References
- 1. Organization WH. Guidelines for preclinical evaluation and clinical trials in osteoporosis. World Health Organization; 1998.
- 2. Xu Q, Pillai SM, Barsony J et al. SUN-371 Hyponatremia Correction Normalizes Bone Mineral Density and Bone Fragility in Rats. Journal of the Endocrine Society 2020; 4: SUN-371.
- 3. Patel M, Ayus JC, Moritz ML. Fragility fractures and reversible osteopaenia due to chronic hyponatraemia in an adolescent male. BMJ Case Reports CP 2019; 12: e229875.
- 4. Huh SY, Gordon CM. Fractures in hospitalized children. Metabolism 2013; 62: 315-325.
- 5. Krell RW, Girotti ME, Dimick JB. Extended length of stay after surgery: complications, inefficient practice, or sick patients? JAMA surgery 2014; 149: 815-820.
- 6. Cheng HH, Carmona F, McDavitt E et al. Fractures related to metabolic bone disease in children with congenital heart disease. Congenital heart disease 2016; 11: 80-86.
- 7. Society TPEaD. CHILD METRICS. In: 2020:
- 8. De Onis M. WHO child growth standards. Geneva: WHO 2006; 1Á336.
- 9. David Strauss RS, Jordan Brooks. New Growth Charts. In: 2020:
- 10. Krick J, Murphy-Miller P, Zeger S et al. Pattern of growth in children with cerebral palsy. Journal of the American Dietetic Association 1996; 96: 680-685.
- 11. Schonfeld-Warden N, Warden CH. Pediatric obesity: an overview of etiology and treatment. Pediatric Clinics of North America 1997; 44: 339-361.
- 12. Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 2011; 96: 1911-1930.
- 13. Pektaş MK, Koyuncu H, Kundak AA. Long bone fractures in neonatal intensive care units of Afyonkarahisar: Five-year’s experience. Turkish Journal of Obstetrics and Gynecology 2019; 16: 219.
- 14. Fortin K, Bertocci G, Nicholas JL et al. Long bone fracture characteristics in children with medical conditions linked to bone health. Child Abuse & Neglect 2020; 103: 104396.
- 15. Jesus AO, Stevenson RD. Optimizing Nutrition and Bone Health in Children with Cerebral Palsy. Physical Medicine and Rehabilitation Clinics 2020; 31: 25-37.
- 16. Henderson RC, Lark RK, Gurka MJ et al. Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics 2002; 110: e5-e5.
- 17. Rehberg M, Azim M, Martakis K et al. Bone microarchitecture assessed by Trabecular Bone Score is independent of mobility level or height in pediatric patients with cerebral palsy. J Bone Miner Res 2020.
- 18. Wasserman HM, Hornung LN, Stenger PJ et al. Low bone mineral density and fractures are highly prevalent in pediatric patients with spinal muscular atrophy regardless of disease severity. Neuromuscular Disorders 2017; 27: 331-337.
- 19. Faienza MF, D'Amato G, Chiarito M et al. Mechanisms involved in childhood obesity-related bone fragility. Frontiers in endocrinology 2019; 10: 269.
- 20. Mohamed N, Makaranka S, Cheema K et al. Bilateral acetabular fractures induced by an epileptic seizure in a paediatric patient: a unique case and its management. BMJ Case Reports CP 2019; 12: e230143.
- 21. Via MA, Gallagher EJ, Mechanick JI. Bone physiology and therapeutics in chronic critical illness. Annals of the New York Academy of Sciences 2010; 1211: 85-94.
- 22. Van den Berghe G, Van Roosbroeck D, Vanhove P et al. Bone turnover in prolonged critical illness: effect of vitamin D. The Journal of Clinical Endocrinology & Metabolism 2003; 88: 4623-4632.
- 23. Contreras JJ, Hiestand B, O’Neill JC et al. Vitamin D deficiency in children with fractures. Pediatric Emergency Care 2014; 30: 777-781.
- 24. Wesseling K, Bakkaloglu S, Salusky I. Chronic kidney disease mineral and bone disorder in children. Pediatr Nephrol 2008; 23: 195-207.
- 25. Bowles SA, Kurdy N, Davis AM et al. Serum osteocalcin, total and bone-specific alkaline phosphatase following isolated tibial shaft fracture. Annals of clinical biochemistry 1996; 33: 196-200.
- 26. Hirsh J, Warkentin TE, Shaughnessy SG et al. Heparin and low-molecular-weight heparin mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001; 119: 64S-94S.
- 27. Petrisko MA, Skoner JD, Skoner DP. Safety and efficacy of inhaled corticosteroids (ICS) in children with asthma. Journal of Asthma 2008; 45: 1-9.
- 28. Allen DB. Inhaled Corticosteroids and Endocrine Effects in Childhood. Endocrinology and Metabolism Clinics 2020; 49: 651-665.
- 29. Wagner K, Wagner S, Susi A et al. Prematurity does not increase early childhood fracture risk. The Journal of pediatrics 2019; 207: 148-153.
- 30. Mughal MZ. Fractures in children with cerebral palsy. Current osteoporosis reports 2014; 12: 313-318.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 1, 2021 |
| Acceptance Date | May 19, 2021 |
| Published in Issue | Year 2021 Volume: 8 Issue: 3 |
Creative Commons License
Journal of Health Academics is licensed under a Creative Commons Attribution 4.0 International License.