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Increased risk of refeeding syndrome-like hypophosphatemia with high initial amino acid intake in small-for-gestational-age, extremely-low-birthweight infants

Recent nutrition guidelines for extremely-low-birth-weight infants (ELBWIs) recommend implementation of high initial amino acid (AA) supplementation in parenteral nutrition. We sought to evaluate the influence of AA intake on refeeding syndrome-like electrolyte disturbances including hypophosphatemi...

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Published in:PloS one 2019-08, Vol.14 (8), p.e0221042-e0221042
Main Authors: Sung, Se In, Chang, Yun Sil, Choi, Jin Hwa, Ho, Yohan, Kim, Jisook, Ahn, So Yoon, Park, Won Soon
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description Recent nutrition guidelines for extremely-low-birth-weight infants (ELBWIs) recommend implementation of high initial amino acid (AA) supplementation in parenteral nutrition. We sought to evaluate the influence of AA intake on refeeding syndrome-like electrolyte disturbances including hypophosphatemia in ELBWIs. Medical records of 142 ELBWIs were reviewed. Demographic, nutritional, outcome, and electrolyte data were compared between ELBWIs with initial low (1.5 g/kg/day) and high (3 g/kg/day) AA intake. Multivariate analysis was conducted to determine the odds ratio of hypophosphatemia with high AA intake and small-for-gestational-age (SGA) ELBWIs. The incidence of hypophosphatemia and severe hypophosphatemia increased from 51% and 8% in period I to 59% and 20% in period II, respectively (p = 0.36 and < 0.01). Specifically, SGA ELBWIs showed higher incidence of hypophosphatemia than appropriate-for-gestational age (AGA) ELBWIs in period II, whereas there was no difference in period I. For severe hypophosphatemia, SGA ELBWIs presented a 27% incidence versus a 2% incidence in AGA ELBWIs, even with low initial AA intake. Despite no difference in phosphate intake between infants with and without hypophosphatemia, serum phosphate level reached a nadir at the sixth postnatal day and gradually recovered over the second week in infants with hypophosphatemia. In multivariate analyses, the odds ratios for severe hypophosphatemia were 3.6 and 6.6 with high AA intake and SGA status, respectively, with the highest being 18.0 with combined high AA intake and SGA status. In summary, high initial AA intake significantly increased the risk of refeeding syndrome-like electrolyte dysregulations including severe hypophosphatemia in ELBWIs. In SGA ELBWIs, the risk of electrolyte disturbance was significantly higher, even with low initial AA intake. Therefore, new tailored parenteral nutrition protocols starting with lower energy intake and a gradual increase over the first week may be warranted for application in high-risk SGA ELBWIs.
doi_str_mv 10.1371/journal.pone.0221042
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We sought to evaluate the influence of AA intake on refeeding syndrome-like electrolyte disturbances including hypophosphatemia in ELBWIs. Medical records of 142 ELBWIs were reviewed. Demographic, nutritional, outcome, and electrolyte data were compared between ELBWIs with initial low (1.5 g/kg/day) and high (3 g/kg/day) AA intake. Multivariate analysis was conducted to determine the odds ratio of hypophosphatemia with high AA intake and small-for-gestational-age (SGA) ELBWIs. The incidence of hypophosphatemia and severe hypophosphatemia increased from 51% and 8% in period I to 59% and 20% in period II, respectively (p = 0.36 and &lt; 0.01). Specifically, SGA ELBWIs showed higher incidence of hypophosphatemia than appropriate-for-gestational age (AGA) ELBWIs in period II, whereas there was no difference in period I. For severe hypophosphatemia, SGA ELBWIs presented a 27% incidence versus a 2% incidence in AGA ELBWIs, even with low initial AA intake. Despite no difference in phosphate intake between infants with and without hypophosphatemia, serum phosphate level reached a nadir at the sixth postnatal day and gradually recovered over the second week in infants with hypophosphatemia. In multivariate analyses, the odds ratios for severe hypophosphatemia were 3.6 and 6.6 with high AA intake and SGA status, respectively, with the highest being 18.0 with combined high AA intake and SGA status. In summary, high initial AA intake significantly increased the risk of refeeding syndrome-like electrolyte dysregulations including severe hypophosphatemia in ELBWIs. In SGA ELBWIs, the risk of electrolyte disturbance was significantly higher, even with low initial AA intake. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Open Access: DOAJ - Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sung, Se In</au><au>Chang, Yun Sil</au><au>Choi, Jin Hwa</au><au>Ho, Yohan</au><au>Kim, Jisook</au><au>Ahn, So Yoon</au><au>Park, Won Soon</au><au>Baud, Olivier</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased risk of refeeding syndrome-like hypophosphatemia with high initial amino acid intake in small-for-gestational-age, extremely-low-birthweight infants</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-08-23</date><risdate>2019</risdate><volume>14</volume><issue>8</issue><spage>e0221042</spage><epage>e0221042</epage><pages>e0221042-e0221042</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Recent nutrition guidelines for extremely-low-birth-weight infants (ELBWIs) recommend implementation of high initial amino acid (AA) supplementation in parenteral nutrition. We sought to evaluate the influence of AA intake on refeeding syndrome-like electrolyte disturbances including hypophosphatemia in ELBWIs. Medical records of 142 ELBWIs were reviewed. Demographic, nutritional, outcome, and electrolyte data were compared between ELBWIs with initial low (1.5 g/kg/day) and high (3 g/kg/day) AA intake. Multivariate analysis was conducted to determine the odds ratio of hypophosphatemia with high AA intake and small-for-gestational-age (SGA) ELBWIs. The incidence of hypophosphatemia and severe hypophosphatemia increased from 51% and 8% in period I to 59% and 20% in period II, respectively (p = 0.36 and &lt; 0.01). Specifically, SGA ELBWIs showed higher incidence of hypophosphatemia than appropriate-for-gestational age (AGA) ELBWIs in period II, whereas there was no difference in period I. For severe hypophosphatemia, SGA ELBWIs presented a 27% incidence versus a 2% incidence in AGA ELBWIs, even with low initial AA intake. Despite no difference in phosphate intake between infants with and without hypophosphatemia, serum phosphate level reached a nadir at the sixth postnatal day and gradually recovered over the second week in infants with hypophosphatemia. In multivariate analyses, the odds ratios for severe hypophosphatemia were 3.6 and 6.6 with high AA intake and SGA status, respectively, with the highest being 18.0 with combined high AA intake and SGA status. In summary, high initial AA intake significantly increased the risk of refeeding syndrome-like electrolyte dysregulations including severe hypophosphatemia in ELBWIs. In SGA ELBWIs, the risk of electrolyte disturbance was significantly higher, even with low initial AA intake. Therefore, new tailored parenteral nutrition protocols starting with lower energy intake and a gradual increase over the first week may be warranted for application in high-risk SGA ELBWIs.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31442245</pmid><doi>10.1371/journal.pone.0221042</doi><tpages>e0221042</tpages><orcidid>https://orcid.org/0000-0002-8245-4692</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
ispartof PloS one, 2019-08, Vol.14 (8), p.e0221042-e0221042
issn 1932-6203
1932-6203
language eng
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source Open Access: PubMed Central; Publicly Available Content (ProQuest)
subjects Acids
Age
Amino acids
Amino Acids - metabolism
Analysis
Biology and Life Sciences
Birth weight
Birth Weight - physiology
Demographics
Dietary supplements
Electrolytes
Electrolytes - metabolism
Energy intake
Female
Gestational Age
Health aspects
Humans
Hypophosphatemia
Hypophosphatemia - epidemiology
Hypophosphatemia - metabolism
Hypophosphatemia - pathology
Incidence
Infant
Infant, Extremely Low Birth Weight - metabolism
Infant, Newborn
Infant, Small for Gestational Age - metabolism
Infants
Low birth weight
Magnesium - metabolism
Male
Medical records
Medicine
Medicine and Health Sciences
Mortality
Multivariate analysis
Newborn babies
Nutrition
Nutritional requirements
Parent-child relations
Parenteral Nutrition
Pediatrics
People and Places
Phosphates
Phosphates - metabolism
Physical Sciences
Practice guidelines (Medicine)
Refeeding Syndrome - epidemiology
Refeeding Syndrome - metabolism
Refeeding Syndrome - pathology
Respiratory Tract Infections - epidemiology
Respiratory Tract Infections - metabolism
Respiratory Tract Infections - pathology
Risk
Sepsis
Small for gestational age
title Increased risk of refeeding syndrome-like hypophosphatemia with high initial amino acid intake in small-for-gestational-age, extremely-low-birthweight infants
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