Factors associated with early phosphate levels in preterm infants

Yakubovich, Daniel; Strauss, Tzipi; Ohana, Dror; Taran, Camelia; Snapiri, Ori; Karol, Dalia; Starez-Chaham, Orna; Kochavi, Briggite; Tsur, Abraham; Morag, Iris

doi:10.1007/s00431-020-03622-7

Cited by 6 publications

(6 citation statements)

References 25 publications

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“…There were only 4 patients with neonatal refeeding syndrome with hypercalcemia and hypophosphatemia at 1 week of life, and 3 of them resolved after second week of life. The result is comparable to most of the clinical studies in which neonatal refeeding syndrome occurs during the first week of life and no cases are reported after 2 weeks of life until now 23,27,29–33 . The major cause of hypophosphatemia in ELBW infant at 2 weeks of life is inadequate mineral supplement, and it could be in infant with either persistent hypophosphatemia after neonatal refeeding syndrome, or gradually lowering serum P level from normal mineral status at 1 week of life.…”

Section: Discussionsupporting

confidence: 81%

“…Early hypophosphatemia is an emerging issue in preterm infants, especially in ELBW, small‐for‐gestational‐age infants and/or infants born following maternal preeclampsia 23–27 . Several studies have reported that early aggressive PN with protein and energy supply increased the risk of electrolyte imbalance, including hypophosphatemia, hypercalcemia, and hypokalemia 24,28–30 .…”

Section: Discussionmentioning

confidence: 99%

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Hypophosphatemia as an Early Metabolic Bone Disease Marker in Extremely Low‐Birth‐Weight Infants After Prolonged Parenteral Nutrition Exposure

Tan

Tsao

Chou

et al. 2020

J Parenter Enteral Nutr

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Background Early metabolic bone disease (MBD) detection is important in preterm infants to decrease long‐term consequence. We aim to explore the early MBD biochemical marker in extremely low‐birth‐weight (ELBW) infants. Methods Retrospective cohort study of 95 preterm infants born in a tertiary care–level neonatal intensive care unit between January 2015 and June 2018, with birth weight <1000 g. Thirty‐five infants were “nothing by mouth” for >14 days and categorized as the high‐risk group; the remaining 60 were categorized as the control group. Mineral intake in the first 14 days and the trend of serum calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP) levels were compared in both groups. Results The Ca and P supplementation in the first 2 weeks of life were inadequate in both groups. Compared with the control group, significantly lower serum P (mg/dL) levels were noted in the high‐risk group on weeks 2 (3.65 ± 1.2 vs 4.67 ± 1.45; P < .001), 4 (3.21 ± 0.95 vs 5.83 ± 1.18; P < .0001), and 6 (3.94 ± 1.1 vs 6.22 ± 0.78; P <.0001). There was no significant difference in the serum Ca level, and significantly higher ALP (U/L) levels were found up until 2 months of life in the high‐risk group (458.36 ± 189.02 vs 335.7 ± 111.51; P < .014). Conclusion Hypophosphatemia developed as early as 2 weeks old in high‐risk preterm infants because of inadequate supplementation. Neither the serum Ca or ALP levels were affected. Thus, the routine monitoring of serum P level should be started 2 weeks after birth for early MBD detection in extremely ELBW infants.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Hypophosphatemia as an Early Metabolic Bone Disease Marker in Extremely Low‐Birth‐Weight Infants After Prolonged Parenteral Nutrition Exposure

Tan

Tsao

Chou

et al. 2020

J Parenter Enteral Nutr

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“…Metabolic disturbances are significantly dependent either on gestational age or birth weight 6,10 . Limited data is available on complex biochemical changes specifically in small for gestational age (SGA) preterm infants 11 .…”

Section: Introductionmentioning

confidence: 99%

High protein intake can lead to serious hypophosphatemia and hypokalemia in growth restricted preterm newborns

Korček,

Straňák

2024

JPGN rep.

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ObjectivesHigh protein parenteral nutrition (HPPN) in the early postnatal period is a recommended strategy for very low birth weight (VLBW) infants. However, limited data is available on electrolyte changes when HPPN strategy is utilized. We investigated the impact of HPPN on the development of hypophosphatemia and hypokalemia in preterm VLBW newborns.MethodsA retrospective, single‐center study investigated the levels of phosphate and potassium in VLBW infants who received HPPN (amino acids intake up to 3.5 g/kg/day) during the first week of life. Preterm infants were divided into two subgroups: appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. Clinical data were obtained from hospital database and medical records.ResultsOverall, 170 VLBW infants were included for the study analysis: 41 SGA (mean birth weight 752 ± 39 g) and 129 AGA infants (mean birth weight 994 ± 23 g). Phosphate and potassium levels were significantly lower in the SGA infants compared to AGA infants (Phosphate: 0.97 ± 0.07 mmol/l vs. 1.44 ± 0.04 mmol/l, p < 0.001; Potassium: 3.0 ± 0.1 mmol/l vs. 3.6 ± 0.1 mmol/l, p < 0.001).ConclusionsRepeated measurement of serum phosphate and potassium is recommended when HPPN strategy is utilized in preterm SGA infants where significant hypophosphatemia and hypokalemia might have serious clinical consequences.

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“…Phosphate (P) is an anion found mainly in the intracellular medium and is vital in several physiological processes 1–4 . It is present in cellular phospholipids, nucleic acids, and adenosine triphosphate (ATP).…”

Section: Introductionmentioning

confidence: 99%

“…Phosphate (P) is an anion found mainly in the intracellular medium and is vital in several physiological processes. [1][2][3][4] It is present in cellular phospholipids, nucleic acids, and adenosine triphosphate (ATP). This anion is involved in acid-basic homeostasis and modulation of oxygen release by hemoglobin.…”

Section: Introductionmentioning

confidence: 99%

Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition

Springer

Hortêncio

Melro

et al. 2021

J Parenter Enteral Nutr

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Background: Hypophosphatemia(HP) is related to several comorbidities in pediatric intensive care units (PICUs). This study aimed to evaluate the incidence of HP in severely ill pediatric patients receiving oral and/or enteral nutrition. The secondary objectives were to investigate the association between HP and the inflammatory state, PICU length of stay, severity, mortality, nutrition status, and protein, energy, calcium, vitamin D, and phosphate intake. Methods:A prospective, observational cohort study was conducted in a PICU of a quaternary hospital. Participants aged between 28 days and 14 years were included.Anthropometric and laboratory assessments were performed ≤72 h after PICU admission and repeated after 7 days for three consecutive times. Energy, protein, calcium, phosphate, and vitamin D intake per day of hospitalization were recorded individually.The Pediatric Index of Mortality 2 (PIM2) was used to determine each patient's severity score.Results: A total of 103 participants were included in the study. Hypophosphatemic events ranged from 27.2% to 37.5% among the assessments. HP was associated with high C-reactive protein levels (P = .012) and lower energy adequacy (P = .037). Serum phosphorus was inversely correlated (weak correlation) with PIM2 (P = .017). Conclusion:HP is common in critically ill pediatric patients, even when they are not receiving parenteral nutrition. It is necessary to monitor serum phosphorus levels and consider the possibility of early replacement, especially in patients showing high levels of inflammation. In addition to inflammation itself, low energy intake and illness severity were related to HP.

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Factors associated with early phosphate levels in preterm infants

Cited by 6 publications

References 25 publications

Hypophosphatemia as an Early Metabolic Bone Disease Marker in Extremely Low‐Birth‐Weight Infants After Prolonged Parenteral Nutrition Exposure

Hypophosphatemia as an Early Metabolic Bone Disease Marker in Extremely Low‐Birth‐Weight Infants After Prolonged Parenteral Nutrition Exposure

High protein intake can lead to serious hypophosphatemia and hypokalemia in growth restricted preterm newborns

Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition

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