Fractures in a tertiary neonatal intensive care unit in Wales

Abstract

Introduction Neonatal fractures raise concern about non-accidental injury (NAI). This case series explores the characteristics of fractures on a neonatal intensive care unit (NICU). Method Babies admitted to a regional NICU from 1998–2007with a radiological fracture during their inpatient stay were identified. Possible aetiology for fractures was identified from in-patient records. Results Fifty-one fractures were identified in 22 (14 male) infants, median (range) gestational age 28 (26–43) weeks and birthweight 1581 (485–4875) g. Fractures occurred at median age of 53 (0–106) days and the sites included 19 anterior or lateral rib, 14 posterior rib, 3 humeral, 2 ulnar, 3 radial, 6 femur, 1 tibial, 2 clavicular and 1 skull. 17 cases had explanations for their fracture including osteopaenia of prematurity, birth trauma, thoracotomy and a witnessed accidental fall. Rib fractures occurred significantly later than other fractures (75.5 vs 21 days, p=0.03) and posterior rib fractures were found in the more preterm babies (26 vs 29 weeks, p=0.04). Babies with rib fractures were more likely to have had a surgical procedure (p=0.01) but fewer had a history of birth trauma (p=0.02). Conclusion Fractures sustained during an inpatient stay on a NICU are unlikely to be associated with NAI. However, this case series demonstrated that fractures occur for a variety of possible associated factors. Careful consideration to causation needs to be given to fractures in babies after discharge from a NICU. Although they could be caused by NAI, prematurity and/or low birthweight and previous treatment needs to be considered.