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Calcium and phosphate requirements of preterm infants who require prolonged hyperalimentation
Insights
Preterm infants need high calcium and phosphate for bone growth during parenteral nutrition. A new alternating infusion method successfully delivers adequate nutrients, preventing catheter obstruction from calcium phosphate precipitation.
Area of Science:
- Neonatal Medicine
- Biochemistry
- Pediatric Nutrition
Background:
- Preterm infants require substantial calcium and phosphate for skeletal mineralization.
- Meeting these needs via parenteral nutrition (PN) is challenging due to solubility limits.
- Transplacental nutrient transfer rates are high (150 mg/kg/day Ca, 80 mg/kg/day P).
Observation:
- Attempts to increase calcium concentration in single PN solutions led to calcium phosphate precipitation.
- Precipitates obstructed hyperalimentation catheters, limiting calcium delivery.
- A single solution at 125 mL/kg/day with 20 mEq/L calcium provides only 50 mg/kg/day calcium.
Findings:
- A novel approach using two alternating PN solutions (one high in calcium, one high in phosphate) was implemented.
- This regimen successfully delivers 80 mg/kg/day of calcium.
- The alternating method circumvents the precipitation issue encountered with single-solution PN.
Implications:
- This strategy may enable higher calcium and phosphate delivery in PN for preterm infants.
- It offers a potential solution to improve skeletal mineralization in this vulnerable population.
- Further research should validate long-term efficacy and safety.
Abstract:
Preterm infants require large amounts of calcium and phosphate to maintain skeletal mineralization during prolonged hyperalimentation. It is impossible to supply the amount of calcium and phosphate normally acquired transplacentally (150 mg/kg/day of calcium and 80 mg/kg/day of phosphate) with reasonable volumes of a single hyperalimentation solution of a physiological pH. We recently encountered calcium phosphate precipitates plugging our hyperalimentation catheters as we tried to raise the calcium concentration above 20 mEq of calcium per liter of hyperalimentation solution. Such a solution supplies 50 mg/kg/day of calcium when run at 125 mL/kg/day. In an attempt to circumvent this problem, we are currently using two hyperalimentation solutions--one high in calcium and the other high in phosphates--run alternately for 12-hour periods. This regimen supplies 80 mg/kg/day of calcium.