Bustos Lozano Gerardo, Hidalgo Romero Álvaro, Melgar Bonis Ana, Ureta Velasco Noelia, Orbea Gallardo Carlos, Pallás Alonso Carmen
Servicio de Neonatología, Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Red SAMID del Instituto Carlos III, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, España.
Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
An Pediatr (Engl Ed). 2018 Apr;88(4):216-222. doi: 10.1016/j.anpedi.2017.04.010. Epub 2017 Jun 3.
To determine the frequency and magnitude of neonatal hypophosphataemia (<4mg/dL) in a neonatal Intensive Care Unit and to describe risk groups.
Retrospective study of hospitalised newborns over a 44 month period (phase 1). Retrospective study of <1,500g/<32 weeks of gestation newborns over a 6 month period (phase 2). Prospective study of <1,500g or 1,550-2,000g, and intrauterine growth restriction (IUGR) newborns. Measurements were made on the 1st, 3rd, 7th, and 14th days of life (phase 3).
Phase 1: 34 (2.4%) of 1,394 patients had a diagnosis of hypophosphataemia, 76% of them ≤32 weeks of gestation and <1500 grams, and 24% >32 weeks with weight<P10. Phase 2: 12 (16.4%) of 73 patients had a diagnosis of hypophosphataemia, with <2mg/dL in 5 (6.8%). Eight (75%) of those with hypophosphataemia had IUGR, and 4 (25%) weighed <1,000g. Five cases had associated hypokalaemia, and three hypercalcaemia. Phase 3: 9 (45%) of 20 patients had hypophosphataemia, all of them <1,000g or<1,200g and weight percentile <10. Thirty-three percent of samples on days 1, 3, and 7 showed hypophosphataemia, four of them <2mg/dL. There was mild hypokalaemia in 5 (55%), and mild hypercalcaemia in 2 (22%) cases. Hypophosphataemia was associated with lower enteral nutrition and higher parenteral amino acid intake in the early days of life.
Hypophosphataemia is common, and can be severe, in the first week of life in premature infants <1,000 grams, and newborns<1,200g with foetal malnutrition and receiving amino acids in early parenteral nutrition.
确定新生儿重症监护病房中新生儿低磷血症（<4mg/dL）的发生率及严重程度，并描述高危群体。
对44个月期间住院新生儿进行回顾性研究（第一阶段）。对孕周<32周、体重<1500g的新生儿进行6个月的回顾性研究（第二阶段）。对体重<1500g或1550 - 2000g且有宫内生长受限（IUGR）的新生儿进行前瞻性研究。在出生后第1、3、7和14天进行测量（第三阶段）。
第一阶段：1394例患者中有34例（2.4%）被诊断为低磷血症，其中76%为孕周≤32周且体重<1500克，24%为孕周>32周且体重<P10。第二阶段：73例患者中有12例（16.4%）被诊断为低磷血症，其中5例（6.8%）血磷<2mg/dL。低磷血症患者中有8例（75%）有IUGR，4例（25%）体重<1000g。5例伴有低钾血症，3例伴有高钙血症。第三阶段：20例患者中有9例（45%）有低磷血症，均为体重<1000g或<1200g且体重百分位数<10。出生后第1、3和7天的样本中有33%显示低磷血症，其中4例血磷<2mg/dL。5例（55%）有轻度低钾血症，2例（22%）有轻度高钙血症。低磷血症与出生早期肠内营养摄入较低及肠外氨基酸摄入量较高有关。
低磷血症在出生体重<1000克的早产儿以及有胎儿营养不良且在出生早期接受肠外营养氨基酸输注的<1200g新生儿出生后第一周很常见，且可能较为严重。
