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Phosphate metabolism in the red cell of sick prematures
V Cholevas1, A Challa, D Lapatsanis
1University of Ioannina, Child Health Department, Greece.
Insights
Early milk feeding in preterm infants effectively prevents phosphate depletion, maintaining crucial erythrocyte phosphate levels and potentially improving tissue oxygenation. This contrasts with total parenteral nutrition, which showed significantly lower phosphate parameters.
Area of Science:
- Neonatal Medicine
- Biochemistry
- Pediatric Nutrition
Background:
- Phosphate metabolism is critical for preterm neonates, especially during the first week of life.
- Nutritional strategies significantly impact phosphate homeostasis in vulnerable infants.
- Preterm infants are at risk for phosphate depletion due to various feeding methods.
Purpose of the Study:
- To investigate the effects of different phosphorus supplementation levels on phosphate metabolism in sick preterm infants.
- To compare phosphate parameters between preterm infants receiving early formula feeding versus total parenteral nutrition.
- To assess the impact of feeding strategies on erythrocyte phosphate levels and 2,3-diphosphoglycerate.
Main Methods:
- Studied three groups of preterm neonates: healthy controls on early formula (A), sick on early formula (B), and sick on total parenteral nutrition (C).
- Measured plasma and red cell inorganic phosphate, erythrocyte ATP, and 2,3-diphosphoglycerate on the 7th day of life.
- Assessed renal tubular reabsorption of phosphate in all groups.
Main Results:
- Sick neonates on total parenteral nutrition (Group C) exhibited significantly lower plasma phosphate, red cell phosphate, erythrocyte ATP, and 2,3-diphosphoglycerate compared to healthy controls (Group A).
- Renal tubular reabsorption of phosphate was also significantly reduced in Group C.
- No significant differences in phosphate parameters were observed between sick neonates on early formula feeding (Group B) and healthy controls (Group A).
Conclusions:
- Early milk feeding, even in sick preterm infants, effectively prevents phosphate depletion and maintains erythrocyte 2,3-diphosphoglycerate levels.
- This suggests early milk feeding may improve tissue oxygenation in preterm neonates.
- The optimal amount of parenteral phosphate supplementation requires further research to benefit red cell phosphate parameters.
Abstract:
The effect of different amounts of phosphorus supplementation on phosphate metabolism was studied in two groups of sick preterms (B and C) during the first week of life. Group B included prematures that started formula milk feeding from day 3 and group C neonates on total parenteral nutrition with phosphate supplementation for 7 days. Twelve healthy preterm neonates on formula milk feeding from day 2 (group A) were used as controls. On the 7th day of life all phosphate parameters measured in group C (plasma and red cell inorganic phosphate and erythrocyte ATP and 2,3-diphosphoglycerate) were found significantly lower than in the controls (1.60 +/- 0.07; 0.60 +/- 0.08; 1.45 +/- 0.09 and 4.42 +/- 0.18 vs. 2.05 +/- 0.10; 0.94 +/- 0.11; 1.69 +/- 0.07 and 6.24 +/- 0.42 mmol/l, respectively). The renal tubular reabsorption of phosphate was also lower in this group (86.8 +/- 3.2 vs. 97.3 +/- 1.0%). No significant differences were observed between groups B and A. Higher phosphorus intake that was better achieved through early milk feeding prevented phosphate depletion and the decline of 2,3-diphosphoglycerate in the erythrocytes even of sick neonates which in turn might help to improve tissue oxygenation. The amount of parenteral phosphate supplementation that could have beneficial effects on red cell phosphate parameters needs further investigation.