Fragility fractures in patients hospitalized in the pediatric intensive care unit

Yıl 2021, Cilt: 8 Sayı: 3, 221 - 226, 01.09.2021

Gürbüz Akçay , Halil Kocamaz , Nazan Bayar Şakın

Öz

Introduction and Objectives:
We aimed to examine the demographic and clinical characteristics of children with Fragility Bone fractures (FF) in our pediatric intensive care unit (PICU) and to evaluate possible risk factors for FF.
Material and methods:
The medical records of patients hospitalized in the PICU in the previous five years were reviewed in terms of their demographic, anatomical, and therapeutic features.
Results:
Seven patients with a total of nine bone fractures were identified. During this period, 807 patients were admitted to the PICU (0.59 fracture cases / 1000 hospitalization days). The median patient age at the time of fracture definition was 5.29±2.82 years (range: 1.39 to 8.43 years). Four patients were diagnosed with congenital quadriplegic cerebral palsy (CP), one with quadriplegia after cerebral venous sinus thrombosis, one with meningomyelocele, and one with spinal muscular atrophy (SMA). Six patients were hospitalized for extended periods. The mean length of hospitalization in patients with bone fractures (73.92 days) was significantly higher than the length of stay of all patients (14.72 days) (p < 0.001). Bone fractures were detected between days two and 165 of admission. Bone fractures were in the humerus in one case and the femur in all others. No patients had a weight percentile <5% based on Turkish national data. Based on evaluation of weight for height, one patient had mild protein-energy malnutrition (PEM), one was overweight, one was obese, and the others were normal. All patients were also diagnosed with epilepsy, were fed by nasogastric tube, and experienced prolonged immobility.
Conclusions:
Patients hospitalized in the PICU are at risk for fragility fractures. Rapid evaluation and treatment in terms of fragility bone fractures should be initiated, particularly in the presence of clinical clues during the follow-up of patients with CP. Conditions that cause long-term immobility such as CP and SMA are the principal risk factors.

Anahtar Kelimeler

Pediatric Intensive Care Units, Bone fractures, Cerebral Palsy, Spinal Muscular Atrophies of Childhood

Pediatrik yoğun bakım ünitesinde yatan hastalarda frajilite kırıkları

Öz

Giriş ve Amaç:
Çocuk yoğun bakım ünitemizde (ÇYBÜ) Frajil Kemik kırığı (FF) olan çocukların demografik ve klinik özelliklerini incelemeyi ve FF için olası risk faktörlerini değerlendirmeyi amaçladık.
Araç ve yöntemler:
Son beş yıl içinde ÇYBB'de yatan hastaların tıbbi kayıtları demografik, anatomik ve terapötik özellikleri açısından gözden geçirildi.
Sonuçlar:
Toplam dokuz kemik kırığı olan yedi hasta belirlendi. Bu dönemde 807 hasta ÇYBB'ye kabul edilmişti (0,59 kırık vakası / 1000 hastanede kalış günü). Kırık tanımlandığı sırada ortalama hasta yaşı 5,29 ± 2,82 yıl (aralık: 1,39 ila 8,43 yıl) idi. Dört hasta konjenital kuadriplejik serebral palsi (SP), bir hasta serebral venöz sinüs trombozu sonrası kuadripleji, bir hasta ise meningomiyelosel ve bir hastaya spinal musküler atrofi (SMA) tanısı konmuştu. Altı hasta uzun süre yatmıştı. Kemik kırığı olan hastalarda ortalama hastanede kalış süresi (73.92 gün) tüm hastaların yatış süresinden (14,72 gün) anlamlı olarak daha yüksekti (p <0,001). Başvurunun ikinci ve 165. günleri arasında kemik kırıkları tespit edildi. Kemik kırıkları bir vakada humerusta, diğerlerinde femurdaydı. Türkiye ulusal verilerine göre hiçbir hastada ağırlık yüzdesi <% 5 değildi. Boy için kilo değerlendirmesine göre, bir hastada hafif protein-enerji malnütrisyonu(PEM) vardı, biri fazla kilolu, biri obezdi, diğerleri normaldi. Tüm hastalara ayrıca epilepsi teşhisi konmuş, nazogastrik tüple beslenmiş ve uzun süreli immobilite tespit edilmişti.
Sonuçlar:
ÇYBB'de hastaneye yatırılan hastalar kırılganlık kırıkları açısından risk altındadır. Özellikle SP'li hastaların takibinde klinik ipuçları varlığında kırılganlık kemik kırıkları açısından hızlı değerlendirme ve tedaviye başlanmalıdır. CP ve SMA gibi uzun süreli hareketsizliğe neden olan koşullar başlıca risk faktörleridir.

Anahtar Kelimeler

Çocuk Yoğun Bakım Ünitesi, Kemik kırıkları, Serebral Palsi, Çocukluk çağı Spinal Müsküler Atrofileri

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