Background and importance Intrauterine growth restriction (IUGR) in neonates can promote the occurrence of electrolyte disturbances. Therefore, some authors propose a modification of parenteral nutrition (PN) in these patients which allows for correcting electrolyte disturbances.
Aim and objectives To evaluate the association between IUGR and the occurrence of calcium and phosphate disturbances in a cohort of premature infants receiving PN.
Material and methods An observational retrospective study was conducted at a third level children’s hospital between January and December 2016. Neonates with a gestational age (GA) <33 weeks and birth weight (BW) <1500 g on PN in the neonatal intensive care unit were included. Biodemographic data (sex, GA and BW), daily PN composition and plasma levels of phosphate and ionised calcium levels during administration of PN were collected from the electronic health record Centricity Critical Care.
We analysed ionised calcium levels because it does not depend on albumin levels. The infants were divided into two groups: IUGR and non-IUGR. Hypophosphataemia was defined as plasma phosphate levels <1.1 mmol/L and hypercalcaemia as plasma calcium ion levels >1.3 mmol/L. Associations between calcium and phosphate, and IUGR were analysed by logistic regression using SPSS V.15.0 (SPSS Inc, Chicago, Illinois, USA) software package.
Results In the IUGR group (n=52, 33 female), GA was 29.39±2.82 weeks and BW was 1047.13±297.41 g. PN composition: 93.20±16.31 mL/kg/day; 59.00±8.61 kcal/kg/day; amino acids 2.96±0.44 g/kg/day; calcium 1.45±0.28 mEq/kg/day; and phosphorus 0.68±0.13 mmol/kg/day. Plasma levels of phosphate were 1.36±0.34 mmol/L and plasma levels of calcium ion were 1.20±0.30 mmol/L; hypophosphataemia 85.48%; hypercalcaemia 34.62%.
In the non-IUGR group (n=62, 32 female), GA was 27.77±2.10 weeks and BW was 1087.42±260.13 g. PN composition: 94.78±18.94 mL/kg/day; 58.56±7.89 kcal/kg/day; amino acids 2.91±0.34 g/kg/day; calcium 1.47±0.19 mEq/kg/day; and phosphorus 0.66±0.14 mmol/kg/day. Plasma levels of phosphate were 1.64±0.34 mmol/L and plasma levels of calcium ion were 1.21±0.25 mmol/L; hypophosphataemia 78.85%; hypercalcaemia 19.35%.
There was no statistically significant difference between the groups with respect to age, GA, BW, PN composition or phosphate and calcium plasma levels. Logistical regression showed a statistically significant relationship between IUGR and hypercalcaemia events (p=0.047). Only weight was associated with hypophosphataemia events (p=0.019).
Conclusion and relevance We found that the IUGR group presented more hypercalcaemia events compared with the non-IUGR group. These results suggest that modification of electrolyte content of the PN in the IUGR group may be a strategy to avoid calcium disturbances.
References and/or acknowledgements No conflict of interest.
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