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J Pediatr Gastroenterol Nutr ; 61(4): 491-8, 2015 Oct.
Article in English | MEDLINE | ID: mdl-25988555

ABSTRACT

OBJECTIVES: The aim of the present study was to evaluate electrolyte and mineral homeostasis in very-low-birth-weight (VLBW) infants who received high protein and energy intakes with a unique standardized parenteral nutrition solution containing electrolytes and minerals from birth onward. METHODS: Prospective cohort study in 102 infants with birth weight <1250 g. The evolution of plasma biochemical parameters was described during the first 2 weeks of life. RESULTS: During the first 3 days of life, mean parenteral intakes were 51 ±â€Š8 kcal · kg · day with 2.7 ±â€Š0.4 g · kg · day of protein, 1.1 ±â€Š0.2 mmol · kg · day of sodium and potassium, and 1.3 ±â€Š0.2 mmol · kg · day of calcium and phosphorus. Afterwards, most nutritional intakes (parenteral and enteral) met growth requirements. No infant developed a hyperkalemia >7 mmol/L, and a hypernatremia >150 mmol/L occurred only in 15.7% of the infants. In contrast, hyponatremia <130 mmol/L and hypokalemia <3 mmol/L occurred in 30.4% and 8.8% of the infants, respectively. The initial neonatal metabolic acidosis rapidly resolved in most infants and only 2.0% developed a base deficit >10 mmol/L after day 3 of life. Early hypocalcemia <1.8 mmol/L occurred in 13.7% of the infants. In contrast, hypophosphatemia <1.6 mmol/L occurred in 37.3% and hypercalcemia >2.8 mmol/L occurred in 12.7% of the infants. CONCLUSIONS: Increasing early protein and energy intakes in VLBW infants in the first week of life improves electrolyte homeostasis. It also increases the phosphorus requirements with a calcium-to-phosphorus ratio ≤1.0 (mmol/mmol) and the potassium and sodium requirements to avoid the development of a refeeding-like syndrome. These data suggest that the parenteral nutrition guidelines for VLBW infants for the first week of life need to be revised.


Subject(s)
Calcium/therapeutic use , Infant Nutritional Physiological Phenomena , Parenteral Nutrition/adverse effects , Phosphorus/therapeutic use , Potassium/therapeutic use , Sodium/therapeutic use , Water-Electrolyte Imbalance/prevention & control , Acidosis/etiology , Acidosis/prevention & control , Acidosis/therapy , Belgium , Calcium/administration & dosage , Cohort Studies , Combined Modality Therapy , Dietary Proteins/administration & dosage , Energy Intake , Enteral Nutrition , Hospitals, University , Humans , Infant, Newborn , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Nutritional Requirements , Phosphorus/administration & dosage , Potassium/administration & dosage , Premature Birth/diet therapy , Premature Birth/physiopathology , Premature Birth/therapy , Prospective Studies , Sodium/administration & dosage , Water-Electrolyte Imbalance/etiology
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