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Acid-base state of the preterm infant and the formulation of intravenous feeding solutions
P MacMahon1, P D Mayne, M Blair
1Department of Child Health, Charing Cross and Westminster Medical School, London.
Insights
Addiphos, an intravenous phosphorus source, can safely increase calcium and phosphorus intake in preterm infants. This study found no significant acid-base disturbances, suggesting a viable method for nutritional support.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Biochemistry
Background:
- Preterm infants often require parenteral nutrition for adequate calcium and phosphorus intake.
- Assessing the acid-base balance is crucial when administering intravenous phosphate sources.
Purpose of the Study:
- To compare the effects of an acidic intravenous phosphorus source (Addiphos) with dipotassium hydrogen phosphate on the acid-base state of preterm infants.
- To evaluate the efficacy of Addiphos in increasing calcium and phosphorus intake without inducing metabolic acidosis.
Main Methods:
- A comparative study involving 25 preterm infants.
- Infants received either Addiphos or dipotassium hydrogen phosphate alternately for 48-hour or 72-hour periods.
- Measurements included calcium and phosphorus intake, plasma concentrations, and acid-base parameters.
Main Results:
- No significant differences in acid-base state were observed between the two solutions in shorter (48-hour) periods.
- Addiphos significantly increased calcium and phosphorus intake and plasma concentrations compared to dipotassium hydrogen phosphate in longer (72-hour) periods.
- Addiphos administration led to lower urine pH and higher titratable acidity, but did not cause significant metabolic acidosis.
Conclusions:
- It is possible to increase calcium and phosphorus intake in preterm infants using Addiphos.
- Addiphos can enhance nutrient delivery without causing significant adverse effects on the acid-base balance.
Abstract:
An acidic intravenous source of phosphorus (Addiphos) was compared with dipotassium hydrogen phosphate in 25 preterm infants to study acid-base state. Eight infants were given either Addiphos or dipotassium hydrogen phosphate alternately for 48 hour periods and similar amounts of calcium and phosphorus were delivered. There were no significant differences in calcium and phosphorus intake, calcium and phosphate plasma concentrations, or acid-base state between study periods on the two solutions. Seventeen infants were given the two solutions alternately for 72 hour periods; Addiphos was used to increase the amounts of calcium and phosphorus being delivered. Calcium and phosphorus intake was decreased on dipotassium hydrogen phosphate, but Addiphos significantly increased calcium and phosphorus intake and plasma calcium and phosphate concentrations. It also lowered the pH of the urine and raised the titratable acidity. Acid-base state, however, was not significantly different. It is therefore possible to increase intake of calcium and phosphorus in preterm infants without causing a significant metabolic acidosis.