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Effects of parenteral phosphorus dose restriction in preterm infants
Insights
Parenteral phosphorus dose restriction in preterm infants led to lower phosphorus levels and higher alkaline phosphatase. Effects were more pronounced in infants over 1250g birth weight during a shortage.
Area of Science:
- Neonatalogy
- Pediatric Intensive Care
- Nutritional Support
Background:
- A national parenteral phosphorus shortage in 2013 necessitated dose restriction strategies.
- Phosphorus use was limited in preterm infants, with stricter limits for those >1250g birth weight.
Purpose of the Study:
- To assess the impact of parenteral phosphorus dose restriction on preterm infants in the neonatal intensive care unit.
Main Methods:
- A comparative study of preterm infants (≤35 weeks gestation, ≤2500g birth weight) receiving parenteral nutrition.
- Cases (during phosphorus shortage) were compared to controls (pre-shortage) for clinical and laboratory data in the first 4 weeks of life.
Main Results:
- Infants during the shortage had lower serum phosphorus and higher alkaline phosphatase levels.
- Greater inotropic support was needed in the shortage group, particularly in infants >1250g birth weight.
Conclusions:
- Parenteral phosphorus restriction showed modest effects, especially in preterm infants >1250g.
- Clinical significance may increase with prolonged or severe shortages, or in extremely preterm infants.
Background:
In response to a national shortage of parenteral phosphorus solutions (2013), a hospital-wide phosphorus dose restriction strategies was implemented which included judicious use of phosphorus in preterm infants <1250 g birth weight and no parenteral phosphorus in preterm infants >1250 g birth weight unless they have a critically low phosphorus level.
Objective:
To study the effect of parenteral phosphorus dose restriction in preterm infants admitted to the neonatal intensive care unit.
Methods:
Preterm infants (≤35 weeks birth gestation and ≤2500 g birth weight) who received parenteral nutrition, survived >1 week and had no major congenital anomalies were studied. Clinical and laboratory data in the first 4 weeks of life of infants admitted during the parenteral phosphorus shortage (cases) were compared to infants who were admitted 6 months prior to the shortage (controls).
Results:
Twenty consecutive cases were compared to 40 consecutive controls. Cases had lower serum phosphorus levels, higher serum alkaline phosphatase levels, and need for greater inotropic support compared to controls. These differences were significant only in preterm infants with birth weight >1250 g, the group who received more parenteral phosphorus dose restriction while they were similar in preterm infants with birth weight <1250 g.
Conclusion:
The modest effects of phosphorus dose restriction may become more clinically important if shortage is prolonged or severe or if it involves extreme preterm infants.
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