Hipofosfemia en recién nacidos prematuros: un trastorno bimodal

Abstract

New nutritional approaches to treat extreme premature babies have demonstrated relevant eviden ce of metabolic disturbances with early hypophosphatemia, especially in patients with intrauterine growth restriction (IUGR). They have shown late hypophosphatemia, as well, which is characteristic in the metabolic bone disease. A sytematic search of literature describing metabolic disturbances of phosphorus in preterm newborns is presented, related to the use of early parenteral nutrition and also in the context of metabolic bone disease. The articles were gathered from electronic data bases, such as PubMed and Rima. We include articles in english and spanish which were selected by titles and abstracts. Several strategies for early nutrition have been proposed in order to ensure an adequate amount of nutrients to accomplish the development and growth of preterm babies. Patients with parenteral nutrition support with different doses of phosphate, or inadequate calcium phosphate relation, or an increased amino acid content, may present hypophosphatemia, hypercalcemia, hy pomagnesemia, hypokalemia and hyperglycemia, all of these are additionally noteworthy in the pre sence of intrauterine growth restriction. Furthermore, said alterations are associated with prolonged mechanical ventilation, as well as bronchopulmonary dysplasia and increase in late onset sepsis. The late hypophosphatemia, described several years ago, arises as normocalcemia and as an increment of alkaline phosphatases in the metabolic bone disease in preterm babies, and also with an inadequate mineralization in different grades, secondary to an inadequate supply due to high nutritional requi rements in these patients. When early or late hypophosphatemia appears in preterm babies, it shall require timely control of phosphemia and will need to adjust the nutritional intake in order to correct it. In case of preterm babies with early parenteral nutrition it will also need a control of calcemia in the first week of birth, especially if those belonging to the IUGR group. Adjustment must be made along with metabolic follow up, as well. In late hypophosphatemia, a weekly or every two weeks fo llow up will be a must for all preterm babies in risk and they should be given supplements to get an optimum mineral supply.

Nomogram for predicting early hypophosphatemia in term infants

“…Approximately 94% of newborns with birth weight under 1,000 g had hypophosphatemia among them [26]. Tariq et al reported that there was persistent hypercalcemia in very low birth weight newborns, while serum phosphate levels were consistently lower than the normal range (4-8 mg/ dl) [26][27][28][29]. In recent years, early nutritional management of small and premature infants has become increasingly popular due to its beneficial effects on the nervous system [29].…”

“…Tariq et al reported that there was persistent hypercalcemia in very low birth weight newborns, while serum phosphate levels were consistently lower than the normal range (4-8 mg/ dl) [26][27][28][29]. In recent years, early nutritional management of small and premature infants has become increasingly popular due to its beneficial effects on the nervous system [29]. However, this nutritional strategy makes them more prone to electrolyte disturbances, including hypophosphatemia.…”

Negative Outcomes Associated with Medication in Neonates on Parenteral Nutrition Therapy

“…In turn, uncontrolled chronic hypophosphatemia can cause respiratory and myocardial failure due to ATP depletion of the myocyte, rhabdomyolysis, anemia, hemolysis, seizures, and metabolic acidosis [ 33 ].…”