Effect on metabolic bone disease markers in the neonatal intensive care unit with implementation of a practice guideline

To determine the effect of implementing a 2015 policy for the screening, prevention, and management of metabolic bone disease for very low birth weight (VLBW) infants in two Level IV NICUs. Retrospective cohort study of VLBW infants in the 2 years prior to (2013–2014) and after (2016–2017) policy implementation. We identified 316 VLBW infants in 2013–2014 and 292 in 2016–2017 who met study criteria. After policy implementation, vitamin D supplementation began earlier (20.1 ± 15.5 days vs 30.2 ± 20.1 days, p  800 IU/L (11.7 vs 4.5%, p = 0.0001) and phosphorous <4 mg/dL (14.2% vs 7.9%, p = 0.014) fell significantly. After policy implementation, vitamin D supplementation began significantly earlier and the rate of detecting abnormal biochemical markers of metabolic bone disease decreased significantly.