title: Metabolic bone disease in very-low-birth-weight infants: assessment, prevention, and treatment by neonatal nurse practitioners.
abstract: OBJECTIVE
  To describe the current practice of neonatal nurse practitioners in assessing skeletal health and preventing and treating metabolic bone disease in very-low-birth-weight infants.
  
  
  METHODS
  Descriptive, retrospective survey.
  
  
  METHODS
  Neonatal nurse practitioners in the continental United States were systematically randomly selected. A 64% response rate was obtained (112).
  
  
  METHODS
  Responses to questions about assessing skeletal health and preventing and treating metabolic bone disease in very-low-birth-weight infants.
  
  
  RESULTS
  Current practice of neonatal nurse practitioners includes assessing skeletal health of very-low-birth-weight infants on the 7th (47.3%) or 14th (19.6%) day of life, with subsequent assessments every 7 (63.3%) or 14 (18.8%) days. Neonatal nurse practitioners (85.1%) estimate the incidence of metabolic bone disease at less than 15%. Neonatal nurse practitioners initiate total parenteral nutrition (99%), provide parenteral calcium and phosphorous in ratios of 1.3-1.7:1 (9%), and add powdered fortifier (90.1%) and liquid fortifier (25.2%) to expressed breast milk. All respondents use formulas made for premature infants. Physical therapy is used by 46.8% of neonatal nurse practitioners.
  
  
  CONCLUSIONS
  Neonatal nurse practitioners underestimate the incidence of metabolic bone disease. Parenteral calcium and phosphorous are given but in quantities that differ from the recommended ratio. Most neonatal nurse practitioners use formulas made for premature infants and add powdered fortifier to expressed breast milk. Although physical therapy is prescribed, more research on its effect on bone mineralization is warranted before this practice is recommended without reservation.
authors.affiliation: University of Utah College of Nursing, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Smith
authors.forename: K T
authors.initials: KT
authors.lastname: Kirchhoff
mesh_terms: D001851:Bone Diseases, Metabolic / Q000451:nursing* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D017283:Neonatal Nursing / Q000379:methods*; D009722:Nurse Practitioners; D009730:Nursing Assessment / Q000379:methods*; D015403:Nursing Evaluation Research; D018529:Nutritional Support; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D011795:Surveys and Questionnaires