Delayed Introduction of Parenteral Phosphorus Is Associated with Hypercalcemia in Extremely Preterm Infants

Hair, Amy B.; Chetta, Katherine E.; Bruno, Ann M.; Hawthorne, Keli M.; Abrams, Steven A.

doi:10.3945/jn.115.228254

Cited by 11 publications

(17 citation statements)

References 16 publications

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“…Enriched formula and/or phosphate depletion can cause hypercalcemia in preterm newborns and, less frequently, in newborns born at term . Phosphate depletion may suppress secretion of FGF23, alleviating the inhibitory effect of FGF23 on 1,25(OH) 2 D 3 production (Fig.…”

Section: Pth‐independent Hypercalcemiamentioning

confidence: 99%

“…The data on plasma PTH concentrations from such babies is scant and it has been suggested that as the hypercalcemia is associated with hypophosphatemia and increased plasma 1,25(OH) 2 D 3 concentrations, then the plasma PTH is likely to be low . The hypercalcemia in these very low birth weight babies fed breast milk, which has a relatively high calcium to phosphate content, can be ameliorated by early administration of phosphate supplements …”

Section: Pth‐independent Hypercalcemiamentioning

confidence: 99%

“…(88) The mechanisms causing the hypercalcemia are unknown, although the hypercalcemia does appear to respond to dietary calcium restriction suggesting increased intestinal absorption as a possible etiology. (88) Acquired causes of neonatal hypercalcemia Nutritional Enriched formula and/or phosphate depletion can cause hypercalcemia in preterm newborns (89) and, less frequently, in newborns born at term. (90) Phosphate depletion may suppress secretion of FGF23, alleviating the inhibitory effect of FGF23 on 1,25(OH) 2 D 3 production ( Fig.…”

Section: Down Syndromementioning

confidence: 99%

“…(90) The hypercalcemia in these very low birth weight babies fed breast milk, which has a relatively high calcium to phosphate content, can be ameliorated by early administration of phosphate supplements. (89)…”

Section: Down Syndromementioning

confidence: 99%

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Hypercalcemic Disorders in Children

Stokes

Nielsen

Hannan

et al. 2017

Journal of Bone and Mineral Research

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Hypercalcemia is defined as a serum calcium concentration that is greater than two standard deviations above the normal mean, which in children may vary with age and sex, reflecting changes in the normal physiology at each developmental stage. Hypercalcemic disorders in children may present with hypotonia, poor feeding, vomiting, constipation, abdominal pain, lethargy, polyuria, dehydration, failure to thrive, and seizures. In severe cases renal failure, pancreatitis and reduced consciousness may also occur and older children and adolescents may present with psychiatric symptoms. The causes of hypercalcemia in children can be classified as parathyroid hormone (PTH)‐dependent or PTH‐independent, and may be congenital or acquired. PTH‐independent hypercalcemia, ie, hypercalcemia associated with a suppressed PTH, is commoner in children than PTH‐dependent hypercalcemia. Acquired causes of PTH‐independent hypercalcemia in children include hypervitaminosis; granulomatous disorders, and endocrinopathies. Congenital syndromes associated with PTH‐independent hypercalcemia include idiopathic infantile hypercalcemia (IIH), William's syndrome, and inborn errors of metabolism. PTH‐dependent hypercalcemia is usually caused by parathyroid tumors, which may give rise to primary hyperparathyroidism (PHPT) or tertiary hyperparathyroidism, which usually arises in association with chronic renal failure and in the treatment of hypophosphatemic rickets. Acquired causes of PTH‐dependent hypercalcemia in neonates include maternal hypocalcemia and extracorporeal membrane oxygenation. PHPT usually occurs as an isolated nonsyndromic and nonhereditary endocrinopathy, but may also occur as a hereditary hypercalcemic disorder such as familial hypocalciuric hypercalcemia, neonatal severe primary hyperparathyroidism, and familial isolated primary hyperparathyroidism, and less commonly, as part of inherited complex syndromic disorders such as multiple endocrine neoplasia (MEN). Advances in identifying the genetic causes have resulted in increased understanding of the underlying biological pathways and improvements in diagnosis. The management of symptomatic hypercalcemia includes interventions such as fluids, antiresorptive medications, and parathyroid surgery. This article presents a clinical, biochemical, and genetic approach to investigating the causes of pediatric hypercalcemia. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

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Section: Pth‐independent Hypercalcemiamentioning

confidence: 99%

Section: Pth‐independent Hypercalcemiamentioning

confidence: 99%

Section: Down Syndromementioning

confidence: 99%

Section: Down Syndromementioning

confidence: 99%

See 2 more Smart Citations

Hypercalcemic Disorders in Children

Stokes

Nielsen

Hannan

et al. 2017

Journal of Bone and Mineral Research

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“…Hypokalaemia and hypophosphataemia are associated with increased parenteral AA provision [45,46,47,48]. Delayed introduction of phosphate (as in the scNPN regimen protocol) has been shown to lead to hypophosphataemia [49]. Quantifying additional electrolyte/mineral needs following the introduction of standardised NPN regimens helps to optimise future formulations [50].…”

Section: Discussionmentioning

confidence: 99%

Attainment Targets for Protein Intake Using Standardised, Concentrated and Individualised Neonatal Parenteral Nutrition Regimens

Morgan

Tan

2019

Nutrients

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Neonatal parenteral nutrition (NPN) regimens that are individualised (iNPN) or standardised concentrated NPN (scNPN) are both currently used in preterm clinical practice. Two recent trials (one iNPN and one scNPN) each compared standard (control) and high (intervention) parenteral protein and energy dosage regimens and provided data about actual protein intake. We hypothesised that scNPN regimens would achieve a higher percentage of the target parenteral protein intake than their corresponding iNPN regimens. We calculated the daily individual target parenteral protein intake and used the daily parenteral protein intake to calculate the target attainment for protein intake in each infant for the two control (iNPN: n = 59, scNPN: n = 76) and two intervention (iNPN: n = 65; scNPN: n = 74) groups. The median (IQR) target attainment of high-dose protein was 75% (66–85) versus 94% (87–97) on days 1–15 for iNPN and scNPN regimens respectively (p < 0.01). The median (IQR) target attainment of standard dose protein was 77% (67–85) versus 94% (91–96) on days 1–15 for iNPN and scNPN regimens, respectively (p < 0.01). This was associated with improved weight gain (p = 0.050; control groups only) and head growth (p < 0.001; intervention groups only). scNPN regimens have better target attainment for parenteral protein intakes than iNPN regimens.

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Quality improvement project in a neonatal intensive care unit reduced the prevalence and duration of hypophosphatemia with significant and sustainable results

et al. 2023

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BackgroundHypophosphatemia is associated with prolonged mechanical ventilation and may affect growth, bone mineralization, nephrocalcinosis, and mortality in preterm infants. Optimal nutrition practices may decrease risk for hypophosphatemia and improve outcome.MethodsA quality improvement project was established to improve parenteral and enteral phosphorus intake with the goal to decrease prevalence and duration of hypophosphatemia in the first 14 days in infants <32 weeks' gestation.ResultsAmong 406 preterm infants, the prevalence of moderate hypophosphatemia decreased from 44% to 19% (P < 0.01) over 4 years. The median duration of moderate hypophosphatemia decreased from 72 h (48–128) to 24 (24–53) (P < 0.01). Daily intakes of parenteral calcium and phosphorus on the fourth day of life increased from 1.5 to 2.5 mEq/kg/day (P < 0.01) and 0.6 to 1.3 mmol/kg/day (P < 0.01), respectively. The median postnatal age of first serum phosphorus concentration assessment decreased from 53 h (41–64) to 32 (24–40) (P < 0.01).ConclusionDuring this quality improvement project, reduced prevalence and duration of hypophosphatemia in infants <32 weeks' gestation in the first 14 days of life was achieved through the optimization of parenteral and enteral phosphorus intake and improved response to acute hypophosphatemia.

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Delayed Introduction of Parenteral Phosphorus Is Associated with Hypercalcemia in Extremely Preterm Infants

Abstract: Early introduction of phosphorus in PN solutions is associated with reduced incidence of whole blood iCa abnormalities in the first week of life and should be considered for ELBW infants. Ongoing evaluation of optimal mineral provision to this population after birth should be performed.

Cited by 11 publications

References 16 publications

Hypercalcemic Disorders in Children

Hypercalcemic Disorders in Children

Attainment Targets for Protein Intake Using Standardised, Concentrated and Individualised Neonatal Parenteral Nutrition Regimens

Quality improvement project in a neonatal intensive care unit reduced the prevalence and duration of hypophosphatemia with significant and sustainable results

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