Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 6, June, p. 841–847
Publication type: original article
Early hypophosphatemia in very low birth weight preterm infants
1 Department and Clinic of Neonatology, University Hospital, Wroclaw Medical University, Poland
Background. Refeeding Syndrome (RFS) is a well-known group of symptoms which occur after the introduction of enteral or parenteral nutrition in undernourished patients. Intrauterine growth restriction (IUGR) is the equivalent of postnatal RFS following the beginning of feeding. The aggressive parenteral nutrition of neonates with very low birth weight (VLBW) resulting from the termination of intrauterine transplacental nutrition is a source of biochemical disorders.
Objectives. The aim of this study was to analyze metabolic disorders in preterm infants during the 1st week of life and to determine the hypophosphatemia risk factors in low birth weight neonates receiving parenteral nutrition. The retrospective analysis covered 49 neonates, aged between 24 0/7 and 32 6/7 weeks of gestation.
Material and Methods. The examined patients were divided into 2 groups according to the level of phosphates during the 1st week of life: HP (n = 18) with aggravated hypophosphatemia (≤3.1 mg/dL) and NP (n = 31) with normal phosphatemia (>3.1 mg/dL).
Results. Hypophosphatemia was observed in the first days of life in 61% of children, in 45% of whom a subsequent test revealed a further fall in the phosphate level. In the rest of the preterm neonates (39%), hypophosphatemia was revealed between the 4th and 7th day of life. The risk of early hypophosphatemia was higher in neonates with IUGR (p = 0.0001; RR 5.2, 95% CI 2.2–12.4) and extremely low birth weight (ELBW) preterm infants (p < 0.05).
Conclusion. Early hypophosphatemia should be closely monitored early in life, especially in newborns with ELBW and IUGR. Further research is needed to develop an optimal nutritional regimen from the first days of life.
nutrition, neonatology, hypophosphatemia, metabolic, preterm infant
- Adamkin D, Radmacher P. Current trends and future challenges in neonatal parenteral nutrition. J Neonatal Perinatal Med. 2014;7:157–164.
- Nehra D, Carlson S, Erica M, et al. The American Society for Parenteral and Enteral Nutrition ( ASPEN) clinical guidelines: Nutrition support of neonatal patients at risk for metabolic bone disease. J Parenter Enteral Nutr. 2013;37:570–598.
- Hay WW, Jr. Aggressive nutrition of the preterm infant. Curr Pediatr Rep. 2013;1(4):222–239. doi:10.1007/s40124–013-0026-4
- Embleton ND, Morgan C, King C. Balancing the risks and benefits of parenteral nutrition for preterm infants: Can we define the optimal composition? Arch Dis Child Fetal Neonatal Ed. 2015;100:F72–F75.
- Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition. 2001;17:632–637.
- Khan LU, Ahmed J, Khan S, Macfie J. Refeeding syndrome: A literature review. Gastroenterol Res Pract.2011;410971. doi:10.1155/2011/410971
- Skipper A. Refeeding syndrome or refeeding hypophosphatemia: A systematic review of cases. Nutr Clin Pract. 2012;27:34–40.
- Byrnes MC, Stangenes J. Refeeding in the ICU: An adult and pediatric problem. Curr Opin Clin Nutr Metab Care. 2011;14:186–192.
- Bonsante F, Iacobelli S, Latorre G, et al. Initial amino acid intake influences phosphorusus and calcium homeostasis in preterm infants: It is time to change the composition of the early parenteral nutrition. PLoS ONE. 2013;8:e72880. doi:10.1371/journal.pone.0072880
- Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr.2013;13:59. doi:10.1186/1471-2431-13-59
- Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005;41:1–87.
- Fenton TR, Lyon AW, Rose MS. Cord blood calcium, phosphate, magnesium, and alkaline phosphatase gestational age-specific reference intervals for preterm infants. BMC Pediatr. 2011;11:76. doi:10.1186/1471-2431-11-76
- Sikora P. Phosphataemia disturbances in children. Pediatr Dypl. 2014;18:37–44.
- Moltu SJ, Strømmen K, Blakstad EW, et al. Enhanced feeding in very-low-birth-weight infants may cause electrolyte disturbances and septicemia: A randomized, controlled trial. Clin Nutr. 2013;32:207–212.
- Ross JR, Finch C, Ebeling M, Taylor SN. Refeeding syndrome in very-low-birth-weight intrauterine growth-restricted neonates. J Perinatol. 2013;33:717–720.
- Boubred F, Herlenius E, Bartocci M, et al. Extremely preterm infants who are small for gestational age have a high risk of early hypophosphatemia and hypokalemia. Acta Paediatr. 2015;104:1077–1083.
- Moco S, Collino S, Rezzi S, Martin FP. Metabolomics perspectives in pediatric research. Pediatr Res. 2013;73:570–576.
- Alexandre-Gouabau MC, Courant F, Moyon T, et al. Maternal and cord blood LC-HRMS metabolomics reveal alterations in energy and polyamine metabolism, and oxidative stress in very-low-birth-weight Infants. J Proteome Research.2013;12:2764–2778.
- Mizumoto H, Mikami M, Oda H, Hata D. Refeeding syndrome in a small-for-dates micro-preemie receiving early parenteral nutrition. Pediatr Int.2012;54:715–717.
- Brener Dik PH, Galletti MF, Fernández Jonusas SA, et al. Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition. J Perinatol. 2015;35:712–715.
- Christmann V, de Grauw AM, Visser R, Matthijsse RP, van Goudoever JB, van Heijst AF. Early postnatal calcium and phosphorusus metabolism in preterm infants. J Pediatr Gastroenterol Nutr. 2014;58:398–403.
- Antachopoulos C, Margeli A, Giannaki M, et al. Transient hypophosphataemia associated with acute infectious disease in paediatric patients. Scand J Infect Dis. 2002;34:836–839.
- Naffaa ME, Mustafa M, Azzam M, et al. Serum inorganic phosphorous level predict 30-day mortality in patients with community acquired pneumonia. BMC Infect Dis.2015;15:332. doi:10.1186/s12879-015-1094-6
- Koletzko B, Poindexter B, Uauy R. Nutritional care of preterm infants: Scientific basis and practical guidelines. Indian J Med Res. 2016;143(4):531–532. doi:10.4103/0971-5916.184296
- Lafeber HN, van de Lagemaat M, Rotteveel J, van Weissenbruch M. Timing of nutritional interventions in very-low-birth-weight infants: Optimal neurodevelopment compared with the onset of the metabolic syndrome. Am J Clin Nutr. 2013;98:556–560.
- Jamin A, D’Inca R, Le FN, et al. Fatal effects of a neonatal high-protein diet in low-birth-weight piglets used as a model of intrauterine growth restriction. Neonatology. 2010;97:321–328.
- Bolisetty S, Pharande P, Nirthanakumaran L, et al. Improved nutrient intake following implementation of the consensus standardized parenteral nutrition formulations in preterm neonates before-after intervention study. BMC Pediatr. 2014,14:309. doi:10.1186/s12887-014-0309
- Imel EA, Econs MJ. Approach to the hypophosphatemic patient. J Clin Endocrinol Metab. 2012;97:696–706.