期刊
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
卷 45, 期 1, 页码 65-78出版社
WILEY
DOI: 10.1002/jpen.1934
关键词
amino acids; fluids-electrolytes; acid-base; hypophosphatemia; intraventricular hemorrhage; mortality; neonates; parenteral nutrition; preterm; proteins; refeeding syndrome
资金
- New Zealand Health Research Council [14/174]
- Cure Kids [3550, 3580]
- Lotteries Grants Board [3705291]
- A+ Trust [A+5854]
- Gravida: National Centre for Growth and Development
- Nurture Foundation [STF 13-19]
- Gravida: National Centre for Growth and Development scholarship
- Neige Todhunter Award
- Yvonne A M Smith Charitable Trust grant
- Starship Foundation
This study found that neonatal refeeding syndrome (RS) is common in extremely low-birth-weight (ELBW) babies and is associated with increased morbidity and mortality. Small-for-gestational-age babies were more likely to develop RS, while the intake of IV protein and phosphate affected the incidence of RS.
Background Refeeding syndrome (RS) following preterm birth has been linked to high intravenous (IV) protein intake in the presence of low electrolyte supply. In extremely low-birth-weight (ELBW) babies, we aimed to determine the incidence of RS and associations with birth characteristics and clinical outcomes. Method Prospective cohort study of ELBW ProVIDe Trial participants in 6 New Zealand neonatal intensive care units. RS was defined as serum phosphate < 1.4 mmol.L(-1)and total calcium > 2.8 mmol.L-1. Relationships between RS and other factors were explored using 2-sample tests and logistic regression adjusted for sex, gestation, and birth-weightz-score. Results Of 338 babies (mean [SD] birth-weight, 780 (134) g, gestational age, 25.9 [1.7] weeks), 68 (20%) had RS. Mortality was greater in babies with RS (32% vs 11%;P< .0001). More small- than appropriate-for-gestational-age babies developed RS (22% vs 8%;P= .001). Growth from birth to 36 weeks' corrected age was not different between babies who did and did not have RS. In logistic regression, the odds of RS decreased by 70% for each 1 mmol per kg(-1).d(-1)IV phosphate intake (odds ratio [OR], 0.3; CI, 0.1-0.6;P= .002) and increased by 80% for each 1 g.kg(-1).d(-1)IV protein intake (OR, 1.8; CI, 1.3-2.7;P= .002). Conclusions Neonatal RS is common in this cohort of ELBW babies and is associated with increased morbidity and mortality. Optimizing phosphate and calcium intakes in IV nutrition solutions may reduce RS and its consequences.
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