High incidence of fracture events in patients with Long-Gap Esophageal Atresia (LGEA): A retrospective review prompting implementation of standardized protocol

• Published in: Bone Reports 2015-12, Vol.3 (C), p.1-4
• Main Authors: Bairdain, Sigrid, Dodson, Brenda, Zurakowski, David, Rhein, Lawrence, Snyder, Brian D, Putman, Melissa, Jennings, Russell W
• Format: Article
• Language: English
• ISSN: 2352-1872; 2352-1872
• DOI: 10.1016/j.bonr.2015.06.002

To identify factors associated with an increased risk of fractures in Long-Gap Esophageal Atresia (LGEA) patients. Following implementation of a risk-stratified program, we hypothesized a reduction in fracture incidence within this potentially high-risk population. A retrospective review of LGEA-patients admitted between 2005 and 2014 was conducted. Symptomatic fractures with radiographic confirmation were defined as events. Univariate and multivariable analysis evaluated factors including admission weight-for-age z-score, primary versus secondary Foker process (FP), weight at Foker Stage I, days and episodes of paralysis, number of parenteral nutrition (PN) days, cumulative dose of loop diuretics adjusted for body weight and days exposed, and exposure to non-loop diuretics. A fracture-prevention protocol was initiated in 2012; incidence was evaluated pre and post-intervention. Fifty-nine patients met inclusion criteria. Twenty-three (39%) patients in the entire cohort incurred at least one fracture during their hospitalization utilizing the Foker process. Given this high percentage, a targeted fracture-prevention protocol was initiated in 2012. Fracture incidence decreased from 48% prior to the protocol to 21% following the protocol (  = 0.046). Several variables that were associated with an increased risk of fractures on univariate analysis included prior esophageal anastomosis attempt (  = 0.008), number of separate episodes of paralysis (  = 0.002), exposure to non-loop diuretics (  = 0.006), cumulative loop diuretic dose (