broken bones in the NICU

[PriceNCRN]

Anyone have infants in the NICU come up with broke bones? I cannot find anything on this topic and possible causes. Can long term TPN and Lipids cause or lead to osteopenia? Wouldn't it show up in labs if this was the case. I am not referring to cases of Osteogenisis Imperfecta. What else could be some causes, I was always under the impression that infant and young childrens bones are fairly difficult to break compared to adults due to the fact they have not completed calcification.

[Mira]

We had an ex-preemie b4 w CLD exacerbated with so many things,he was on dexamethasone+diuretics.One time I was warned to be careful when moving him because he`s got a fractured bone(`forgot if hip or leg).Apparently because of the above meds(more on diuretics),absorption of minerals for bone formation diminished resulting to fragile bones.

I would love to hear more explanation about this condition as well.:)

[prmenrs, RN]

Lasix is especially bad at leaching Ca++ from bones. Before there was Spiralactolone (?sp), which is a combo of steroid and aldactazide, babies would develop rickets, and fractures would result from ordinary handling. Make sure to get them off Lasix asap, give supplements (HMF and premie formulas provide more Ca and phosphorous than regular formulas or non fortified breast milk), esp Vit D.

I haven't seen it much recently--less chronic babies, but certainly something to be aware of.

[NicuGal, MSN, RN]

Phenobarb is another that can do a number on bones. We watch the alk phos levels and start Vit D when they get too high.

We used to have "rickets" a lot when I started, but with all the advances in Hal and IL infusions, we never see it anymore!

[SheaTabRN]

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How high??? I'm new in the NICU and often see the Alk Phos levels get really high on labs. I must confess that I pass it on and no one really seems all that excited about it. So, how high is too high??

Also, in what form do you give vit D? AND... do you give vit D when Cacium levels are fine?

Thanks!