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Early phosphate supplementation reduces refeeding syndrome and improves clinical outcomes in very-preterm infants: A
Suzan S Asfour1, Belal Alshaikh2, Latifah AlMahmoud3
1Clinical Pharmacy Department, Pharmaceutical Services, King Saud Medical City, Riyadh, 12746, Saudi Arabia.
Insights
Early phosphate supplementation in total parenteral nutrition (TPN) significantly reduced refeeding syndrome (RFS) in very-preterm infants. This intervention also improved clinical outcomes, decreasing sepsis and necrotizing enterocolitis incidence.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Metabolic Complications
Background:
- Refeeding syndrome (RFS) is a critical metabolic complication in preterm infants receiving total parenteral nutrition (TPN).
- Low phosphate intake is a significant risk factor for developing RFS in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of initiating phosphate supplementation on the first day of life.
- To determine if early phosphate supplementation reduces RFS incidence and improves short-term clinical outcomes in very-preterm infants.
Main Methods:
- A retrospective cohort study compared infants before and after the implementation of early phosphate supplementation.
- Inclusion criteria: very-preterm infants (≤ 32 weeks gestation, <1500 g birth weight) receiving TPN immediately after birth.
- Statistical analysis used modified log-Poisson regression with generalized linear models and robust variance estimation.
Main Results:
- A significant reduction in the incidence of refeeding syndrome (RFS) was observed following early phosphate supplementation (P < 0.001).
- Infants receiving early phosphate supplementation also showed lower rates of late-onset sepsis (P = 0.003) and necrotizing enterocolitis (P < 0.001).
Conclusions:
- Early phosphate supplementation in TPN is associated with decreased RFS incidence and improved clinical outcomes in very-preterm infants.
- Further validation through randomized controlled trials is recommended to inform future nutritional guidelines.
Background:
Refeeding syndrome (RFS) is a major metabolic complication that may affect preterm infants during the early days of total parenteral nutrition (TPN), particularly when phosphate intake is low.
Objective:
This study assessed whether early phosphate supplementation initiated on the first day of life reduces the incidence of RFS and improves short-term clinical outcomes in very-preterm infants.
Methods:
A comparative retrospective cohort study (before early phosphate supplementation) and after early phosphate supplementation) was conducted. is study included very-preterm infants who were born at King Saud Medical City, a tertiary referral center, at ≤ 32 weeks of gestation, had a birth weight of <1500 g, had received TPN immediately after birth, and were admitted to a level III neonatal intensive care unit between January 2015 and December 2025. To adjust for potential confounding factors, the modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber-White) were used.
Results:
In total, 962 infants met our inclusion criteria. After the implementation of early phosphate supplementation in TPN, we found a significant reduction in the incidence of RFS (P < 0.001). Further, this group had a lower incidence rate of late-onset sepsis and necrotizing enterocolitis (P = 003, <0.001, respectively).
Conclusions:
Early phosphate supplementation was associated with a reduced incidence of RFS and improved clinical outcomes in very-preterm infants. Nevertheless, randomized controlled trials should be conducted to validate these findings and inform future nutrition guidelines.
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