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The influence of parenteral protein intake on electrolyte disturbances in premature infants
Carlos Javier Parramón-Teixidó1, Laura Gómez-Ganda1, Beatriz Garcia-Palop1
1Pharmacy Service, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Insights
Aggressive parenteral nutrition (PN) in preterm infants did not increase electrolyte imbalances like hypercalcaemia or hypophosphataemia. This study found no significant difference in electrolyte disturbances between low and high amino acid doses in PN for VLBW infants.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Clinical Chemistry
Background:
- Parenteral nutrition (PN) with high amino acid and energy doses is standard for very low birth weight (VLBW) infants to enhance growth and neurodevelopment.
- Emerging evidence suggests this aggressive approach may lead to electrolyte disturbances.
- This study investigates the relationship between amino acid dosage in PN and electrolyte imbalances in VLBW preterm infants.
Purpose of the Study:
- To compare the prevalence of hypercalcaemia, hypophosphataemia, and hypokalaemia in VLBW preterm infants receiving different parenteral nutrition (PN) amino acid doses.
- To identify perinatal and nutritional factors associated with electrolyte imbalances in this population.
Main Methods:
- A retrospective observational study comparing two groups of preterm infants (born <33 weeks gestation, weight <1500g) receiving PN.
- Group 1 received <3g/kg/day of amino acids; Group 2 received ≥3g/kg/day.
- Analysis included electrolyte levels, PN composition, and perinatal data, with adjustments for confounders.
Main Results:
- 114 infants were analyzed (60 low-intake, 54 high-intake).
- No significant differences in hypercalcaemia, severe hypophosphataemia, or hypokalaemia prevalence were observed between groups (P>.99).
- A calcium-to-phosphorus ratio >1.05 demonstrated a protective effect against hypophosphataemia (P=.007).
Conclusions:
- The dose of amino acids in parenteral nutrition (PN) for very low birth weight preterm infants was not associated with increased risk of hypercalcaemia, hypophosphataemia, or hypokalaemia.
- The findings suggest that current aggressive PN strategies may be safe regarding these specific electrolyte disturbances.
- Further research may explore other potential risks or benefits of varying amino acid doses in neonatal PN.
Introduction:
Aggressive parenteral nutrition with delivery of high amino acid and energy doses is used to improve growth and neurodevelopmental outcomes in very low birth weight (VLBW) preterm infants. Recent findings, however, suggest that this approach may cause electrolyte imbalances. The aim of our study was to compare the prevalence of hypercalcaemia, hypophosphataemia, and hypokalaemia in 2 groups of preterm infants that received parenteral nutrition with different amounts of amino acids and to analyse perinatal and nutritional variables associated with the development of electrolyte imbalances.
Methods:
We conducted a retrospective observational study comparing 2 groups of preterm infants born before 33 weeks' gestation with birth weights of less than 1500 g managed with parenteral nutrition. One of the groups received less than 3 g/kg/day of amino acids and the other received 3 g/kg//day of amino acids or more. We analysed the prevalence of electrolyte imbalances and possible associations with aggressive parenteral nutrition, adjusting for potential confounders.
Results:
We studied 114 infants: 60 given less than 3 g/kg/day of amino acids (low-intake group) and 54 given at least 3 g/kg/day (high-intake group). The prevalence of electrolyte imbalances was similar in both groups. The prevalence of hypercalcaemia was 1.67% in the low-intake group and 1.85% in the high-intake group (P > .99), the prevalence of severe hypophosphataemia 11.7% vs 9.3%, and the prevalence of hypokalaemia 15.0% vs 11.1% (P > .99). A calcium to phosphorus ratio greater than 1.05 had a protective effect against hypophosphataemia (P = .007).
Conclusions:
We did not find an association between hypercalcaemia, hypophosphataemia, and hypokalaemia and the amino acid dose delivered by PN in the high-intake group of preterm infants.
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