Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients
Aim To describe the epidemiology and management of appendicular fractures occurring in the neonatal ICU in a large series of patients treated a single, quaternary care neonatal intensive care unit. Methods Patients
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| Veröffentlicht in: | Acta Paediatrica 2021-02, Vol.110 (2), p.489-494 |
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| container_title | Acta Paediatrica |
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| creator | Williams, Brendan A. Makarewich, Christopher A. Montoya‐Williams, Diana C. Krakow, Arielle Lioy, Janet Horn, B. David |
| description | Aim
To describe the epidemiology and management of appendicular fractures occurring in the neonatal ICU in a large series of patients treated a single, quaternary care neonatal intensive care unit.
Methods
Patients |
| doi_str_mv | 10.1111/apa.15430 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2415828492</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2415828492</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4230-e424955e7e70f4f5ef5b3f70a97bae3d3e2581d3422fe759a9899cc7580b77aa3</originalsourceid><addsrcrecordid>eNp10E1L7DAUBuAgis5VF_4BCbjxLqppPibNchj0XkHQha7LmfRkiLRpTVpl_r3RUReCZ3PO4uHl8BJyUrKLMs8lDHBRKinYDpmVc1UWnHO9S2asYqJQXIkD8ielJ8a4MHK-Tw4EV3MphZoRezX4Bjvft_16QyE0tIMAa-wwjLR3FIYBQ-Pt1EKkLoIdp4iJ9tZOMfqwpj7QgH2AEdp8jxiSf0FqISIdYPQ5Jh2RPQdtwuPPfUger68elv-L27t_N8vFbWElF6xAyaVRCjVq5qRT6NRKOM3A6BWgaARyVZWNkJw71MqAqYyxVquKrbQGEIfkfJs7xP55wjTWnU8W2xbyh1OquSxVxStpeKZnP-hTP8WQv8tKG5WlFln93Sob-5QiunqIvoO4qUtWvzdf5-brj-azPf1MnFYdNt_yq-oMLrfg1be4-T2pXtwvtpFv3eONdg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2479541573</pqid></control><display><type>article</type><title>Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>Alma/SFX Local Collection</source><creator>Williams, Brendan A. ; Makarewich, Christopher A. ; Montoya‐Williams, Diana C. ; Krakow, Arielle ; Lioy, Janet ; Horn, B. David</creator><creatorcontrib>Williams, Brendan A. ; Makarewich, Christopher A. ; Montoya‐Williams, Diana C. ; Krakow, Arielle ; Lioy, Janet ; Horn, B. David</creatorcontrib><description>Aim
To describe the epidemiology and management of appendicular fractures occurring in the neonatal ICU in a large series of patients treated a single, quaternary care neonatal intensive care unit.
Methods
Patients <1 years old with appendicular fractures treated from 2012 to 2016 at a quaternary‐level NICU were identified. Bivariate testing compared fractures, work‐up and management based on designated mechanism (presumed birth‐related vs unknown). In patients with unknown mechanism, factors with potential fracture association were analysed in a descriptive fashion.
Results
Eighty‐five fractures (54 patients) were included. Mechanistic cohorts differed by birthweight (P < .001) and gestational age at birth (P < .001). Presumed birth‐related fractures were more commonly upper extremity (P < .001), solitary (P = .001) and radiographically diagnosed in the acute state (<.001). The biochemical profile of the cohorts differed significantly. The prevalence of factors with potential fracture association was high in patients with unknown mechanism. Only one patient required surgery, while all others resolved with minimal orthopaedic intervention.
Conclusion
Findings indicate these injuries rarely require operative intervention and that two distinct injury profiles appear to exist based on fracture mechanism. Steroid use, ventilation use, diuretic use, nutritional supplementation and recent bedside procedures were common among patients without known fracture mechanism.
Level of Evidence
Level III—Retrospective Cohort Study.</description><identifier>ISSN: 0803-5253</identifier><identifier>EISSN: 1651-2227</identifier><identifier>DOI: 10.1111/apa.15430</identifier><identifier>PMID: 32564435</identifier><language>eng</language><publisher>Norway: Wiley Subscription Services, Inc</publisher><subject>appendicular fracture ; Birth weight ; birth‐related injury ; clavicle fracture ; Dietary supplements ; Diuretics ; Epidemiology ; Fractures ; Fractures, Bone - epidemiology ; Fractures, Bone - etiology ; Fractures, Bone - therapy ; Gestational age ; Humans ; Infant ; Infant, Newborn ; Intensive care ; Intensive Care, Neonatal ; long bone fracture ; neonatal fractures ; Neonates ; Retrospective Studies ; Surgery</subject><ispartof>Acta Paediatrica, 2021-02, Vol.110 (2), p.489-494</ispartof><rights>2020 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd</rights><rights>2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.</rights><rights>2021 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4230-e424955e7e70f4f5ef5b3f70a97bae3d3e2581d3422fe759a9899cc7580b77aa3</citedby><cites>FETCH-LOGICAL-c4230-e424955e7e70f4f5ef5b3f70a97bae3d3e2581d3422fe759a9899cc7580b77aa3</cites><orcidid>0000-0001-6247-4146 ; 0000-0002-1239-2123 ; 0000-0002-5882-1181</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapa.15430$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapa.15430$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32564435$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Williams, Brendan A.</creatorcontrib><creatorcontrib>Makarewich, Christopher A.</creatorcontrib><creatorcontrib>Montoya‐Williams, Diana C.</creatorcontrib><creatorcontrib>Krakow, Arielle</creatorcontrib><creatorcontrib>Lioy, Janet</creatorcontrib><creatorcontrib>Horn, B. David</creatorcontrib><title>Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients</title><title>Acta Paediatrica</title><addtitle>Acta Paediatr</addtitle><description>Aim
To describe the epidemiology and management of appendicular fractures occurring in the neonatal ICU in a large series of patients treated a single, quaternary care neonatal intensive care unit.
Methods
Patients <1 years old with appendicular fractures treated from 2012 to 2016 at a quaternary‐level NICU were identified. Bivariate testing compared fractures, work‐up and management based on designated mechanism (presumed birth‐related vs unknown). In patients with unknown mechanism, factors with potential fracture association were analysed in a descriptive fashion.
Results
Eighty‐five fractures (54 patients) were included. Mechanistic cohorts differed by birthweight (P < .001) and gestational age at birth (P < .001). Presumed birth‐related fractures were more commonly upper extremity (P < .001), solitary (P = .001) and radiographically diagnosed in the acute state (<.001). The biochemical profile of the cohorts differed significantly. The prevalence of factors with potential fracture association was high in patients with unknown mechanism. Only one patient required surgery, while all others resolved with minimal orthopaedic intervention.
Conclusion
Findings indicate these injuries rarely require operative intervention and that two distinct injury profiles appear to exist based on fracture mechanism. Steroid use, ventilation use, diuretic use, nutritional supplementation and recent bedside procedures were common among patients without known fracture mechanism.
Level of Evidence
Level III—Retrospective Cohort Study.</description><subject>appendicular fracture</subject><subject>Birth weight</subject><subject>birth‐related injury</subject><subject>clavicle fracture</subject><subject>Dietary supplements</subject><subject>Diuretics</subject><subject>Epidemiology</subject><subject>Fractures</subject><subject>Fractures, Bone - epidemiology</subject><subject>Fractures, Bone - etiology</subject><subject>Fractures, Bone - therapy</subject><subject>Gestational age</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intensive care</subject><subject>Intensive Care, Neonatal</subject><subject>long bone fracture</subject><subject>neonatal fractures</subject><subject>Neonates</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><issn>0803-5253</issn><issn>1651-2227</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10E1L7DAUBuAgis5VF_4BCbjxLqppPibNchj0XkHQha7LmfRkiLRpTVpl_r3RUReCZ3PO4uHl8BJyUrKLMs8lDHBRKinYDpmVc1UWnHO9S2asYqJQXIkD8ielJ8a4MHK-Tw4EV3MphZoRezX4Bjvft_16QyE0tIMAa-wwjLR3FIYBQ-Pt1EKkLoIdp4iJ9tZOMfqwpj7QgH2AEdp8jxiSf0FqISIdYPQ5Jh2RPQdtwuPPfUger68elv-L27t_N8vFbWElF6xAyaVRCjVq5qRT6NRKOM3A6BWgaARyVZWNkJw71MqAqYyxVquKrbQGEIfkfJs7xP55wjTWnU8W2xbyh1OquSxVxStpeKZnP-hTP8WQv8tKG5WlFln93Sob-5QiunqIvoO4qUtWvzdf5-brj-azPf1MnFYdNt_yq-oMLrfg1be4-T2pXtwvtpFv3eONdg</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Williams, Brendan A.</creator><creator>Makarewich, Christopher A.</creator><creator>Montoya‐Williams, Diana C.</creator><creator>Krakow, Arielle</creator><creator>Lioy, Janet</creator><creator>Horn, B. David</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TM</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6247-4146</orcidid><orcidid>https://orcid.org/0000-0002-1239-2123</orcidid><orcidid>https://orcid.org/0000-0002-5882-1181</orcidid></search><sort><creationdate>202102</creationdate><title>Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients</title><author>Williams, Brendan A. ; Makarewich, Christopher A. ; Montoya‐Williams, Diana C. ; Krakow, Arielle ; Lioy, Janet ; Horn, B. David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4230-e424955e7e70f4f5ef5b3f70a97bae3d3e2581d3422fe759a9899cc7580b77aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>appendicular fracture</topic><topic>Birth weight</topic><topic>birth‐related injury</topic><topic>clavicle fracture</topic><topic>Dietary supplements</topic><topic>Diuretics</topic><topic>Epidemiology</topic><topic>Fractures</topic><topic>Fractures, Bone - epidemiology</topic><topic>Fractures, Bone - etiology</topic><topic>Fractures, Bone - therapy</topic><topic>Gestational age</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intensive care</topic><topic>Intensive Care, Neonatal</topic><topic>long bone fracture</topic><topic>neonatal fractures</topic><topic>Neonates</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Williams, Brendan A.</creatorcontrib><creatorcontrib>Makarewich, Christopher A.</creatorcontrib><creatorcontrib>Montoya‐Williams, Diana C.</creatorcontrib><creatorcontrib>Krakow, Arielle</creatorcontrib><creatorcontrib>Lioy, Janet</creatorcontrib><creatorcontrib>Horn, B. David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta Paediatrica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Williams, Brendan A.</au><au>Makarewich, Christopher A.</au><au>Montoya‐Williams, Diana C.</au><au>Krakow, Arielle</au><au>Lioy, Janet</au><au>Horn, B. David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients</atitle><jtitle>Acta Paediatrica</jtitle><addtitle>Acta Paediatr</addtitle><date>2021-02</date><risdate>2021</risdate><volume>110</volume><issue>2</issue><spage>489</spage><epage>494</epage><pages>489-494</pages><issn>0803-5253</issn><eissn>1651-2227</eissn><abstract>Aim
To describe the epidemiology and management of appendicular fractures occurring in the neonatal ICU in a large series of patients treated a single, quaternary care neonatal intensive care unit.
Methods
Patients <1 years old with appendicular fractures treated from 2012 to 2016 at a quaternary‐level NICU were identified. Bivariate testing compared fractures, work‐up and management based on designated mechanism (presumed birth‐related vs unknown). In patients with unknown mechanism, factors with potential fracture association were analysed in a descriptive fashion.
Results
Eighty‐five fractures (54 patients) were included. Mechanistic cohorts differed by birthweight (P < .001) and gestational age at birth (P < .001). Presumed birth‐related fractures were more commonly upper extremity (P < .001), solitary (P = .001) and radiographically diagnosed in the acute state (<.001). The biochemical profile of the cohorts differed significantly. The prevalence of factors with potential fracture association was high in patients with unknown mechanism. Only one patient required surgery, while all others resolved with minimal orthopaedic intervention.
Conclusion
Findings indicate these injuries rarely require operative intervention and that two distinct injury profiles appear to exist based on fracture mechanism. Steroid use, ventilation use, diuretic use, nutritional supplementation and recent bedside procedures were common among patients without known fracture mechanism.
Level of Evidence
Level III—Retrospective Cohort Study.</abstract><cop>Norway</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32564435</pmid><doi>10.1111/apa.15430</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-6247-4146</orcidid><orcidid>https://orcid.org/0000-0002-1239-2123</orcidid><orcidid>https://orcid.org/0000-0002-5882-1181</orcidid></addata></record> |
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| subjects | appendicular fracture Birth weight birth‐related injury clavicle fracture Dietary supplements Diuretics Epidemiology Fractures Fractures, Bone - epidemiology Fractures, Bone - etiology Fractures, Bone - therapy Gestational age Humans Infant Infant, Newborn Intensive care Intensive Care, Neonatal long bone fracture neonatal fractures Neonates Retrospective Studies Surgery |
| title | Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients |
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