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Published on: September 20, 2019
Sodium Glycerophosphate vs. Inorganic Phosphate Use in Parenteral Nutrition for Preterm Infants: A Retrospective
Jung-Ting Chang1, Yu-Jun Chang2, Lih-Ju Chen1
1Department of Neonatology, Changhua Christian Children's Hospital, No. 320, Xuguang Rd., Changhua City 500010, Taiwan.
Insights
Sodium glycerophosphate in parenteral nutrition for preterm infants led to higher phosphate levels and lower seizure risk compared to inorganic phosphate. Further research is needed to confirm these findings in neonates.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Clinical Chemistry
Background:
- Parenteral nutrition (PN) is crucial for preterm neonates.
- Optimizing PN composition is essential to prevent complications.
- Sodium glycerophosphate is a potential alternative to inorganic phosphate in PN.
Purpose of the Study:
- To compare the effects of sodium glycerophosphate versus inorganic phosphate in PN for preterm infants.
- To evaluate outcomes including metabolic bone disease and electrolyte imbalance.
- To assess the impact on growth parameters and specific morbidities.
Main Methods:
- Retrospective cohort study of 402 preterm neonates.
- Comparison of PN with sodium glycerophosphate (n=205) versus inorganic phosphate (n=197).
- Analysis of growth parameters, nutrient content, serum levels (calcium, phosphorus, ALP), and morbidities.
Main Results:
- Sodium glycerophosphate group had higher PN calcium and phosphate content.
- Higher mean serum phosphate and lower serum alkaline phosphatase (ALP) in the sodium glycerophosphate group.
- Reduced seizure incidence and increased hypocalcemia incidence in the sodium glycerophosphate group.
- No significant differences in other morbidities like metabolic bone disease or bronchopulmonary dysplasia.
Conclusions:
- Sodium glycerophosphate in PN is associated with improved phosphate levels and reduced seizures in preterm infants.
- Higher hypocalcemia incidence noted with sodium glycerophosphate requires attention.
- Further randomized controlled trials are necessary due to the retrospective, single-center nature of this study.
Background/Objectives:
Sodium glycerophosphate improves the adverse side effects of parenteral nutrition. Therefore, this study aimed to evaluate different outcomes, including metabolic bone disease and electrolyte imbalance, associated with the use of sodium glycerophosphate or inorganic phosphate in parenteral nutrition for preterm neonates.
Methods:
This retrospective cohort study enrolled 402 newborns admitted to the neonatal intensive care unit of one medical center between January 2019 and September 2021. Of them, 205 received sodium glycerophosphate as parenteral nutrition, while the other 197 received inorganic phosphate. Baseline characteristics and growth parameters, including body weight, body length, and head circumference in the first year of life; calcium and phosphate content of parenteral nutrition in the first 4 weeks; calcium, phosphorus, alkaline phosphatase (ALP), and creatinine levels; and morbidities were compared.
Results:
During the first 4 weeks, the calcium and phosphate contents of parenteral nutrition were significantly higher in the sodium glycerophosphate vs. inorganic phosphate group. Growth parameters did not differ significantly between groups. The sodium glycerophosphate group showed a higher mean serum phosphate level (4.0 ± 1.2 mg/dL vs. 3.5 ± 1.3 mg/dL, p = 0.001), lower serum ALP level (402.8 ± 202.8 U/L vs. 466.4 ± 228.6 U/L, p = 0.004), lower seizure incidence (4.9% vs. 13.2%, p = 0.003), and higher hypocalcemia incidence (41.5% vs. 31.5%, p = 0.038). However, there were no significant intergroup differences in other common morbidities such as metabolic bone diseases of prematurity, bronchopulmonary dysplasia, electrolyte imbalance, hypoglycemia, retinopathy of prematurity, or intraventricular hemorrhage.
Conclusions:
Compared to inorganic phosphate, sodium glycerophosphate is associated with higher serum phosphate levels, lower ALP levels, and reduced seizure incidence in premature infants. However, as the study was retrospective and single-center, further randomized controlled trials are needed to confirm these findings.
