Use of sodium glycerophosphate in neonatal parenteral nutrition solutions to increase calcium and phosphate compatibility for preterm infants

Abstract

Background: Preterm infants require higher calcium and phosphate intake than term infants to facilitate adequate bone growth, but this is rarely met in parenteral nutrition (PN) solution because of the limited solubility of calcium and phosphate. This study aimed to evaluate the solubility of organic phosphate with calcium gluconate in neonatal PN solutions, simulating its clinical use. Methods: PN solutions were composed of calcium gluconate at 50 mEq/L and sodium glycerophosphate (NaGP) at 25 mmol/L. Another component included 1% or 4% amino acid and 10% or 20% dextrose. For comparison, PN solution composed of potassium phosphate was also evaluated. Each solution was evaluated using the following methods: visual inspection, light obscuration particle count test, and pH measurement. To simulate the clinical condition, the solution was tested after compounding, after being stored at 25 C for 24 h, and after being stored at 2 C-8 C for 2 or 9 days and subsequently at 25 C for 24 h. Results: There was no visual deposition in PN solution using NaGP in any of the concentrations and under any stored condition. The solution fulfilled the criteria of physical compatibility as < 25 particles/mL measuring !10 mm in diameter and <3 particles/mL measuring !25 mm in diameter. On the contrary, visual deposition was evidently noted in PN solution using potassium phosphate after its formulation, and the particle count significantly exceeded the range of physical compatibility. Pediatrics and Neonatology (2020) 61, 331e337 Conclusion: NaGP and calcium gluconate have significantly good compatibility in PN solution. The use of NaGP in neonatal PN prevents calcium and phosphorus precipitation, hence increasing their supply to preterm infants in meeting their growth requirement.

Y-Site Compatibility Studies of Parenteral Nutrition and Other Intravenous Medications in Neonatal and Pediatric Patients: A Review of the Literature Evidence

“…However, the role of phosphates (inorganic or organic) on the stability of PN admixture and therefore their impact on compatibility cannot be ignored. It is well known that PN formulations containing the organic source of phosphates are less prone to destabilization [ 35 , 36 ]. Therefore, drugs compatible with PN admixtures based on organic phosphates cannot be expected to behave in the same way when the phosphate source in PN admixtures is changed to inorganic.…”

Optimising growth in very preterm infants: reviewing the evidence

“…In part, this is due to concerns about stability of these substances in solution and the possibility of precipitation. Studies continue in this area, especially as there is a pressing need to optimise calcium and phosphate delivery to prevent metabolic bone disease of prematurity 40…”

Catch it before it breaks!: managing metabolic bone disease of prematurity

“…Therefore, the calcium and phosphorous should be in the most soluble form possible. Newer solutes in TPN, such as the use of use of sodium glycerophosphate can help decrease calcium and phosphorous precipitation in the solution thereby increasing the amount the infant receives per bag of TPN [23 ▪ ].…”

“…Michaud et al evaluated the risk for future fractures in preterm infants and found that preterm birth was mainly associated with fractures before 18 months of age [18–20]. Other studies suggest that infants with MBDP are 16 times more likely to have rib and long bone fractures before 6 months than infants with no MBDP [23 ▪ ].…”