Risk factors and nursing interventions for non-traumatic fractures in neonates and children: a systematic review with narrative synthesis

Non-traumatic (unexplained) fractures in neonates and children are often detected incidentally and present considerable diagnostic complexity. Nurses have a central role in early recognition, prevention and safe care, yet the synthesis of risk factors and nursing management is limited. This review aimed to synthesise evidence on risk factors for non-traumatic fractures in neonates and children and on the nursing management interventions reported to mitigate risk and improve outcomes. Nine studies were reviewed, including two quality improvement (QI) projects undertaken in neonatal intensive care units. Four main risk factor themes emerged from content analysis and narrative synthesis analysis - prematurity and low birthweight, comorbidities, medicines and nutrition - with additional influences from sex and maternal characteristics. Synthesis of the nursing interventions in the two QI projects identified that a multidisciplinary approach to screening, nutritional optimisation, staff education and 'handle with care' signage reduced non-traumatic fracture rates. Non-traumatic fracture risk in neonates and children is multifactorial, with nursing evidence concentrated in neonatal settings. Nurse-led screening and prevention protocols are research priorities.