Fractures Related to Metabolic Bone Disease in Children with Congenital Heart Disease
| Autor: | Satish Rajagopal, Erica McDavitt, Daniel Wigmore, Frank A. Pigula, Jeannette M. Perez-Rossello, Henry H. Cheng, Fabio Carmona, Catherine M. Gordon, Peter C. Laussen |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Hyperparathyroidism
Pediatrics medicine.medical_specialty Calcitriol Heart disease business.industry Mortality rate 030209 endocrinology & metabolism General Medicine 030204 cardiovascular system & hematology medicine.disease Metabolic bone disease 03 medical and health sciences 0302 clinical medicine Pediatrics Perinatology and Child Health Cohort medicine Vitamin D and neurology Coronary care unit Radiology Nuclear Medicine and imaging Surgery Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Congenital Heart Disease. 11:80-86 |
| ISSN: | 1747-079X |
| DOI: | 10.1111/chd.12293 |
| Popis: | Objective Critically ill children with congenital heart disease (CHD) are at risk for metabolic bone disease (MBD) and bone fractures. Our objective was to characterize a cohort of CHD patients with fractures and describe a Fragile Bone Protocol (FBP) developed to reduce fractures. Design/Setting Patients who developed fractures in the Cardiac Intensive Care Unit (CICU) of Boston Children's Hospital from 3/2008 to 6/2014 were identified via quality improvement and radiology databases. The FBP (initiated July 2011) systematically identifies patients at risk for MBD and prescribes special handling precautions. Results Twenty-three fractures were identified in 15 children. Median age at fracture identification was 6.2 months, with a median duration of hospitalization before fracture diagnosis of 2.7 months. Six patients (40%) had single ventricle CHD. Hyperparathyroidism and low 25-OH vitamin D levels were present in 77% and 40% of those tested, respectively. Compared with patients not diagnosed with fractures, fracture patients had increased exposure to possible risk factors for MBD and had elevated parathyroid and decreased calcitriol levels.Six patients (40%) did not survive to hospital discharge, compared with an overall CICU mortality rate of 2.6% (P < .01). The fracture case rate before implementation of the FBP was 2.6 cases/1000 admissions and was 0.7/1000 after implementation of the FBP (P = .04). Conclusions Critically ill CHD patients are at risk for fractures. They represent a complex group who frequently has hyperparathyroidism and decreased calcitriol levels, and each may predispose to fractures. FBPs consisting of identification and careful patient handling should be considered in at-risk patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text