Prevalence and characteristics of rib fractures in ex-preterm infants

• Published in: Pediatrics (Evanston) Vol. 130; no. 6; p. 1116
• Main Authors: Lucas-Herald, Angela, Butler, Sandra, Mactier, Helen, McDevitt, Helen, Young, David, Ahmed, Syed Faisal
• Format: Journal Article
• Language: English
• Published: United States 01.12.2012
• Subjects: Bone Density; Bone Diseases, Metabolic - diagnostic imaging; Bone Diseases, Metabolic - epidemiology; Bone Diseases, Metabolic - etiology; Child Abuse - diagnosis; Child Abuse - statistics & numerical data; Cross-Sectional Studies; Diagnosis, Differential; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Infant, Premature, Diseases - diagnostic imaging; Infant, Premature, Diseases - epidemiology; Infant, Premature, Diseases - etiology; Intensive Care Units, Neonatal; Male; Mass Screening; Radiography; Rib Fractures - diagnostic imaging; Rib Fractures - epidemiology; Rib Fractures - etiology; Risk Factors; Scotland
• ISSN: 1098-4275
• DOI: 10.1542/peds.2012-0462

This study aimed to identify the prevalence and characteristics of rib fractures in ex-preterm infants. Infants born at <37 weeks' gestation and admitted before 2011 to 3 regional neonatal units were identified from admission registers. For 2 centers, these data were available from 2000 onward and, for another center, from 2005. Electronic records were searched to identify chest radiographs performed up to age 1 year. Chest radiograph reports were then reviewed for evidence of rib fractures, and the case notes of all affected individuals were scrutinized. Of the 3318 eligible preterm infants, 1446 had a total of 9386 chest radiographs. Of these infants, 26 (1.8%) were identified as having a total of 62 rib fractures. Their median (range) gestation at birth was 26 weeks (23-34). The median chronological age of these infants at the time of the radiograph was 14 weeks (5 weeks to 8 months). The median corrected gestational age at the time of the radiograph was 39 weeks (34 weeks to 4 months). Of the 62 fractures, 27 (36%) were sited posteriorly, and 15 (53%) of the infants with posterior rib fractures were diagnosed with osteopathy of prematurity. Classic risk including conjugated hyperbilirubinemia and diuretics, were present in 23 of 26 (88%) infants. A full skeletal survey was performed in 8 of 26 (31%). Investigations for nonaccidental injury occurred in 4 of 26 (15%) cases. Evidence of rib fractures is present in ~2% of ex-preterm infants. The evaluation of these fractures in infancy requires a detailed neonatal history irrespective of the site of rib fracture.