Pająk Agata, Królak-Olejnik Barbara, Szafrańska Agnieszka
Department and Clinic of Neonatology, University Hospital, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2018 Jun;27(6):841-847. doi: 10.17219/acem/70081.
Refeeding Syndrome (RFS) is a well-known group of symptoms which occur after the introduction of enteral or parenteral nutrition in undernourished patients. Intrauterine growth restriction (IUGR) is the equivalent of postnatal RFS following the beginning of feeding. The aggressive parenteral nutrition of neonates with very low birth weight (VLBW) resulting from the termination of intrauterine transplacental nutrition is a source of biochemical disorders.
The aim of this study was to analyze metabolic disorders in preterm infants during the 1st week of life and to determine the hypophosphatemia risk factors in low birth weight neonates receiving parenteral nutrition. The retrospective analysis covered 49 neonates, aged between 24 0/7 and 32 6/7 weeks of gestation.
The examined patients were divided into 2 groups according to the level of phosphates during the 1st week of life: HP (n = 18) with aggravated hypophosphatemia (≤3.1 mg/dL) and NP (n = 31) with normal phosphatemia (>3.1 mg/dL).
Hypophosphatemia was observed in the first days of life in 61% of children, in 45% of whom a subsequent test revealed a further fall in the phosphate level. In the rest of the preterm neonates (39%), hypophosphatemia was revealed between the 4th and 7th day of life. The risk of early hypophosphatemia was higher in neonates with IUGR (p = 0.0001; RR 5.2, 95% CI 2.2–12.4) and extremely low birth weight (ELBW) preterm infants (p < 0.05).
Early hypophosphatemia should be closely monitored early in life, especially in newborns with ELBW and IUGR. Further research is needed to develop an optimal nutritional regimen from the first days of life.
再喂养综合征（RFS）是一组在营养不良患者开始肠内或肠外营养后出现的著名症状群。宫内生长受限（IUGR）相当于出生后开始喂养后的再喂养综合征。由于子宫内经胎盘营养的终止，对极低出生体重（VLBW）新生儿进行积极的肠外营养是生化紊乱的一个来源。
本研究的目的是分析早产儿出生后第1周的代谢紊乱情况，并确定接受肠外营养的低出生体重新生儿低磷血症的危险因素。回顾性分析涵盖了49例妊娠24 0/7至32 6/7周的新生儿。
根据出生后第1周的磷酸盐水平将受检患者分为2组：HP组（n = 18）为严重低磷血症（≤3.1mg/dL），NP组（n = 31）为血磷正常（>3.1mg/dL）。
61%的儿童在出生后的头几天出现低磷血症，其中45%的儿童随后的检查显示磷酸盐水平进一步下降。其余早产儿（39%）在出生后第4至7天出现低磷血症。IUGR新生儿（p = 0.0001；RR 5.2，95%CI 2.2–12.4）和极低出生体重（ELBW）早产儿（p < 0.05）早期低磷血症的风险更高。
应在生命早期密切监测早期低磷血症，尤其是ELBW和IUGR新生儿。需要进一步研究以制定出生后第一天起的最佳营养方案。
