Journal List > Perinatology > v.29(1) > 1094973

Yang, Noh, Lee, and Park: Late and Insufficient Phosphorus Supplementation is Associated with Early Severe Hypophosphatemia in Extremely Low Birth Weight Infants with Early Amino Acid Administration

Abstract

Objective

To investigate the incidence of early severe hypophosphatemia, and examine the associated clinical factors and outcomes, in extremely low birth weight infants (ELBWI) who received early amino acid administration.

Methods

Medical records of 82 ELBWI were retrospectively reviewed. Severe hypophosphatemia was defined as a serum phosphate level <2 mg/dL during the first week after birth.

Results

Nineteen ELBWI (23.2%) experienced severe hypophosphatemia. The supplementation of phosphorus was started significantly later in the hypophosphatemia group compared to that in the control group (P=0.036). Small for gestational age infants (SGAI) (P=0.006) and bronchopulmonary dysplasia (P=0.016) were more prevalent in the hypophosphatemia group compared to that in the control group.

Conclusion

Early severe hypophosphatemia is common in ELBWI. Late and insufficient supplementation of phosphorus and SGAI were associated with severe hypophosphatemia.

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Fig. 1
The patient enrollment flow chart. BW, birth weight.
pn-29-13f1.tif
Fig. 2
The serum phosphate and calcium levels during the first week after birth are shown for the hypophosphate mia and control groups. (A) Mean phosphate levels during the first week after birth: there was no group difference in phosphate level on day 1, but there were significant group differences on day 2 (3.5±1.9 vs. 4.6±1.34 mg/dL, P=0.015), day 4 (1.9 [1.8; 2.2] vs. 3.5 [2.9; 4.3] mg/dL, P<0.001), day 5 (2.0±10.6 vs. 3.8±1.0 mg/dL, P<0.001), and day 7 (2.5±1.2 vs. 3.8±1.0 mg/dL, P<0.001). (B) Mean calcium levels during the first week after birth: on day 5 (10.0 [9.7; 10.8] vs. 9.2 [8.6; 9.9] mg/dL, P=0.012), there was a significant group difference in calcium levels.
pn-29-13f2.tif
Fig. 3
The supplementation of amino acid, phosphorus, and fluid during the first week after birth is shown for the hypophosphatemia and control groups. (A) Amino acids supplementation during the first week after birth: there was no group difference in the amount of amino acid administration during the first week after birth. (B) Phosphorus supplementation during the first week after birth: there were significant group differences in the amount of phosphorus administered on day 4 (0.0 [0.0; 0.5] vs. 0.6 [0.0; 1.0] mmol/kg/day, P=0.37) and day 5 (0.5 [0.0; 1.0] vs. 1.0 [0.8; 1.0] mmol/kg/day, P=0.017). (C) Fluid supplementation during the first week after birth: there was no group difference in the amount of fluid administration.
pn-29-13f3.tif
Table 1.
Patient Characteristics
  Control group (n=63) Hypophosphatemia group (n=19) P-value
Gestational age (wks) 26+0 [25+0; 27+0] 25+6 [24+4; 28+5] 0.847
Birth weight (g) 850 [720; 920] 710 [650; 905] 0.216
Histological chorioamnionitis 28/63 (44.4) 11/19 (57.9) 0.443
SGA 5/63 (7.9) 7/19 (36.8) 0.006
Antenatal steroids     0.603
None 17/63 (27.0) 3/19 (15.8)  
Incomplete use 25/63 (39.7) 9/19 (47.4)  
Complete use 21/63 (33.3) 7/19 (36.8)  
PPROM 10/63 (15.9) 6/19 (31.6) 0.129
Male 31/63 (49.2) 13/19 (68.4) 0.226
Caesarean section 34/63 (53.9) 12/19 (63.2) 0.657
Apgar score      
1 minutes 3 [2; 5] 4 [3; 5] 0.334
5 minutes 6 [4; 6] 6 [5; 6.5] 0.548

Values are presented as median [25; 75 percentile] or number (%). Abbreviations: SGA, small for gestational age; PPROM, preterm premature rupture of membrane.

Table 2.
Clinical Outcomes in the Neonatal Intensive Care Unit
  Control group (n=63) Hypophosphatemia group (n=19) P- value
PDA ligation 30/63 (47.6) 11/19 (57.9) 0.601
IVH (≥grade III) 11/63 (18.0) 7/19 (36.9) 0.475
EUGR 18/63 (28.6) 7/19 (36.8) 0.688
Sepsis 22/63 (34.9) 11/19 (57.9) 0.128
NEC (≥stage IIa) 8/63 (12.7) 4/19 (21.1) 0.594
Duration of TPN (days) 37 [26; 53] 37 [17.5; 60.5] 0.899
ROP (≥stage I) 24/63 (38.1) 5/19 (36.8) 0.346
BPD (≥moderate) 31/52 (59.6) 11/11 (100) 0.016
Duration of mechanical 15 [6; 42.5] 20 [9; 62] 0.361
ventilation (days)      
Mortality 11/63 (17.5) 8/19 (42.1) 0.055

Values are presented as median [25; 75 percentile] or number (%). Abbreviations: SGA, small for gestational age; PPROM, preterm premature rupture of membrane.

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