Aims Non-ambulant children are at risk of low bone mineral density, and an increased susceptibility to fractures. Risk factors for these two problems include decreased weight bearing, use of anticonvulsants, poor nutrition and decreased exposure to sunlight. Recommendations available nationally from RCPCH, and in the wider literature, suggest close monitoring of these at-risk patients, and offer guidance regarding calcium and vitamin D supplementation.
Methods We conducted a retrospective pilot audit based on these recommendations. A sample of non-ambulant children within our patient population, cared for by our neurodisability team, was included, and their case notes and electronic records were audited. We aimed to use the available literature, and our results, to evaluate our current service and establish a local guideline for monitoring bone health and directing mineral supplementation.
Results 14 patients were included in the pilot audit, however records for 1 patient were unobtainable. Baseline biochemistry blood tests at diagnosis, measuring calcium and Vitamin D levels, were only performed in 1 patient. Calcium levels were measured at a later point in time in 10 children (77%), and vitamin D levels in just 3 children (23%). Although the levels measured were within normal range, no children received calcium or vitamin D supplementation at any stage. 8 children subsequently had repeat levels measurements. A fracture was detected in 1 child. No children underwent a DEXA scan for formal assessment of bone mineral density. 11 children had documented dietician involvement.
Conclusion Our current clinical practice was sub-optimal within the sample population. Calcium intake may have been optimised through nutritional assessment and dietician input, however no children were started on additional calcium or vitamin D supplementation. A local guideline has been created and implemented to help address this aspect of patient care, with the additional benefit of facilitating future re-audit in this area.
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