Meeting Mineral Needs in the Very Low Birth Weight Infants

• Published in: Journal of the American Dietetic Association 1995-09, Vol.95 (9), p.A84-A84
• Main Authors: Henry, B.W., Gottschalk, M.E., Myers, T.F., Zeller, W.P.
• Format: Article
• Language: English
• ISSN: 0002-8223; 1878-3570
• DOI: 10.1016/S0002-8223(95)00648-6

Parenteral nutrition (PN) goals for very low birth weight infants (VLBW) must provide high mineral concentrations for rapid bone growth. The risk of PN mineral precipitation rises with calcium (Ca) & phos (Phos) content. To optimize Ca & Phos intake we instituted standard PN orders with a CarPhos ratio of 2.5mEq Ca:1mMol Phos & 4 options of increasing concentrations. To evaluate the system, all VLBW, without primary liver disease, who received PN >1 week were studied. We compared actual PN Ca & Phos intake with advisable PN goals (Tsang, 1994) & available serum levels of Cai, Phos & Alkaline Phosphatase (Alk Phos) for two, successive, one month periods. After 1 month, an education session reviewed PN goals, the ordering options were changed to eliminate the lowest Ca/Phos level & advancement was encouraged. The initial monitor (Group 1) included 13 VLBW infants with normal to high Ca levels & an average Phos intake at 0.85 mMol/kg/d (range 0.3 to 1.4), only 57% of PN goals. In the second month (Group 2), Cai levels were normal in 10 new VLBW, while average Phos intake increased to 1.09 mMol/kg/d (range 0.54 to 1.4), 73% of PN goals. The improvement in Phos intake was significant using the Fisher's Exact test with p500 IU/L, predictive of metabolic bone disease of prematurity, were observed in 3 VLBW, (0.5 to 0.7 mMol phos/kg/d). Overall, the negative correlation of Phos intake with Alk Phos levels (Group 1=10, Group 2=9) was r2=.2 & p=.05. Since Cai levels were not deficient & the incidence of hypercalcemia actually decreased in Group 2 with greater Phos intakes, we conclude the advancement of Phos to meet PN goals is a key factor for bone growth in the VLBW. The nutrition review of goals & outcomes effectively changed ordering practices of PN in the neonatal intensive care unit.