Does Parenteral Nutrition Influence Electrolyte and Fluid Balance in Preterm Infants in the First Days after Birth?

Elstgeest, Liset E.; Martens, Shirley E.; Lopriore, Enrico; Walther, Frans J.; Pas, Arjan B. te

doi:10.1371/journal.pone.0009033

Cited by 20 publications

(12 citation statements)

References 31 publications

(76 reference statements)

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“…This appears in contrast with previous data by Rivera et al (1993) who did not find any influence of AA input on kalemia, in a small randomized trial, and by Elstgeest et al (2010) who compared, in a retrospective study, two different PN regimens, but having also a very dissimilar fluid and electrolyte intake, in the first days of life. Na/K-ATPase impairment is often recognized as responsible for non-oliguric hyperkalemia.…”

Section: Discussioncontrasting

confidence: 99%

The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

et al. 2011

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Background/Objectives: Recent guidelines for preterm parenteral nutrition (PN) recommend an earlier and higher intake of amino acids (AA) and energy to avoid postnatal catabolism and approximate normal fetal growth. Few investigations explored how early PN may affect electrolyte and water homeostasis. We performed a prospective observational trial to assess the effect of nutrient intake on electrolyte homeostasis and balance. Subjects/Methods: During 16 months, all infants p32 weeks were eligible. In the first week of life, we recorded the following daily: electrolytes (plasma and 8-h urine collection), nutritional intake, urine output, body weight, and we calculated sodium (Na) and potassium (K) balance. Infants were divided, for analysis, into three groups of AA intake: low o1.5 g/kg/day (LAA), medium 1.5-2 g/kg/day (MAA) and high 42 g/kg/day (HAA). Results: A total of 154 infants were included. HAA group presented lower weight loss. Na balance was influenced by urine output and postnatal age, with little contribution of nutrition. Kalemia and K balance were mainly influenced by AA intake. K balance differed among groups: LAA, À2.3 mmol/kg/week; MAA, 1.1 mmol/kg/week; and HAA 2.6 mmol/kg/week (Po0.0001). In the HAA group, plasma and urine K were significantly lower and non-oliguric hyperkalemia was reduced. Conclusions: Na homeostasis was very slightly modified by early nutrition, suggesting that a negative Na balance is obligatory after birth. We showed that AA intake strongly affects K balance, minimize hyperkalemia and reduces weight loss. As K balance is strictly linked to cellular metabolism, we speculate that early nutrition may inhibit cellular catabolism and reduce the contraction of intracellular water compartment.

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Section: Discussioncontrasting

confidence: 99%

The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

et al. 2011

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“…17 Elstgeest compared serum sodium values in the first 3 days of life in two cohorts of infants (<28weeks gestation who received early and late TPN) and found no difference in the incidence of hypernatraemia between the two groups. 3 In our study, the mean sodium level was similar in the two groups. The LPN group, however, showed an increased incidence of hypernatraemia compared to the EPN group.…”

Section: Discussionsupporting

confidence: 56%

“…In recent years, early introduction and aggressive advancement of PN have been shown to be safe and effective. 2,3 Protein delivery of 3 gm/kg beginning on day one (D1) of life is safe and associated with plasma AA concentrations similar to those of second and third trimester fetuses. 4 In the absence of iatrogenic causes of electrolyte and acid base derangements, significant individual variations in nutritional requirements of preterm neonates from PN are rare.…”

mentioning

confidence: 99%

Early Versus Late Parenteral Nutrition in Very Low Birthweight Neonates : A Retrospective Study from Oman

Aroor¹,

Krishnan²,

Reyes³

et al. 2012

SQUMJ

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(EPN group, n = 44). Demographic data, anthropometric and laboratory parameters were extracted from the electronic record system. Results: The mean age of PN initiation was LPN = 47.3 hours versus EPN = 14.3 hours. Biochemical parameters analysed during the first week of life revealed a reduction in hypernatraemia (12.7% versus 6.8%) and non-oliguric hyperkalemia (12.7% versus 6.8%) in EPN, with no significant differences in acidosis and urea levels between the two groups. Hyperglycemia >12 mmol/L in <1000g was higher in EPN. Nutritional parameters in 81 babies who survived/stayed in the unit up to a corrected gestational age (CGA) of 34 weeks (40 in LPN and 41 in EPN), revealed a reduction in metabolic bone disease (osteopenia of prematurity [OOP], 17.5% versus 7.3%) and the need for phosphate supplementation (22.5% versus 7.3%) in the EPN group. There was no increase in acidosis or cholestasis. No difference was noted in albumin levels, time to full feeds, time to regain birthweight and mean weight gain per day till 34 weeks corrected CGA. Conclusion: EPN in VLBW newborns is well tolerated and reduces hypernatraemia, non-oliguric hyperkalemia, OOP and the need for phosphate supplementation. Early versus Late Parenteral Nutrition in VeryLow Birthweight Neonates A retrospective study from Oman 1 They are traditionally started on a dextrose infusion and graded to parenteral nutrition (PN) over several days. The goal of EPN is to provide an intravenous substrate that promotes protein deposition and increased lean body mass that approximates fetal growth rate and accretion. In recent years, early introduction and aggressive advancement of PN have been shown to be safe and effective.2,3 Protein delivery of 3 gm/kg beginning on day one (D1) of life is safe and associated with plasma AA concentrations similar to those of second and third trimester fetuses. 4 In the absence of iatrogenic causes of electrolyte and acid base derangements, significant individual variations in nutritional requirements of preterm neonates from PN are rare. 5 Hypothesising that premature infants might benefit from the anabolic effects of EPN without metabolic derangement, we investigated the benefits of EPN in VLBW neonates. The objectives of our study were to compare the following between the EPN and LPN groups: 1) Biochemical disturbances in the first week of life; 2) Weight gain/day, mean weight at 34 weeks corrected gestational age (CGA), time to full feeds and time to regain birth weight, and 3) Incidence of osteopenia, the need for phosphate supplementation, cholestasis and albumin levels. The study included all inborn VLBW babies between and including gestational age 25-32weeks and weighing ≤1500 g; those that survived >7days for assessing biochemical parameters; infants who survived/stayed in the NICU until corrected gestational age (CGA) of 34 weeks for assessing nutritional parameters, and who received PN for >5 days. Excluded from this study were infants with chromosomal and major congenital anomalies; those on PN for >4weeks; ba...

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“…There is some current evidence that water and electrolyte balance, along with micronutrient homeostasis, may be influenced by early aggressive PN [5,6]. In previous investigations we have shown that a higher early Amino Acid (AA) intake may prevent non-oliguric hyperkalemia in very low birth weight infants by inhibiting cellular catabolism and promoting growth [7].…”

Section: Introductionmentioning

confidence: 99%

Initial Amino Acid Intake Influences Phosphorus and Calcium Homeostasis in Preterm Infants – It Is Time to Change the Composition of the Early Parenteral Nutrition

Bonsante

Iacobelli

Latorre³

et al. 2013

PLoS ONE

118

108

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BackgroundEarly aggressive parenteral nutrition (PN), consisting of caloric and nitrogen intake soon after birth, is currently proposed for the premature baby. Some electrolyte disturbances, such as hypophosphatemia and hypercalcemia, considered unusual in early life, were recently described while using this PN approach. We hypothesize that, due to its impact on cell metabolism, the initial amino acid (AA) amount may specifically influence the metabolism of phosphorus, and consequently of calcium. We aim to evaluate the influence of AA intake on calcium-phosphorus metabolism, and to create a calculation tool to estimate phosphorus needs.MethodsProspective observational study. Phosphate and calcium plasma concentrations and calcium balance were evaluated daily during the first week of life in very preterm infants, and their relationship with nutrition was studied. For this purpose, infants were divided into three groups: high, medium and low AA intake (HAA, MAA, LAA). A calculation formula to assess phosphorus needs was elaborated, with a theoretical model based on AA and calcium intake, and the cumulative deficit of phosphate intake was estimated.Results154 infants were included. Hypophosphatemia (12.5%) and hypercalcemia (9.8%) were more frequent in the HAA than in the MAA (4.6% and 4.8%) and in the LAA group (0% and 1.9%); both p<0.001.DiscussionCalcium-phosphorus homeostasis was influenced by the early AA intake. We propose to consider phosphorus and calcium imbalances as being part of a syndrome, related to incomplete provision of nutrients after the abrupt discontinuation of the placental nutrition at birth (PI-ReFeeding syndrome).We provide a simple tool to calculate the optimal phosphate intake. The early introduction of AA in the PN soon after birth might be completed by an early intake of phosphorus, since AA and phosphorus are (along with potassium) the main determinants of cellular growth.

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Does Parenteral Nutrition Influence Electrolyte and Fluid Balance in Preterm Infants in the First Days after Birth?

Cited by 20 publications

References 31 publications

The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

Early Versus Late Parenteral Nutrition in Very Low Birthweight Neonates : A Retrospective Study from Oman

Initial Amino Acid Intake Influences Phosphorus and Calcium Homeostasis in Preterm Infants – It Is Time to Change the Composition of the Early Parenteral Nutrition

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