Early hypophosphatemia in very low birth weight preterm infants.

BACKGROUND

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.

OBJECTIVES

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.

MATERIAL AND METHODS

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).

RESULTS

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).

CONCLUSIONS

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.