1
|
Merheb R, Arumugam C, Lee W, Collin M, Nguyen C, Groh-Wargo S, Nelson S. Neonatal Serum Phosphorus Levels and Enamel Defects in Very Low Birth Weight Infants. JPEN J Parenter Enteral Nutr 2016; 40:835-41. [DOI: 10.1177/0148607115573999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/19/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Roula Merheb
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Chitra Arumugam
- Department of Pediatrics, Division of Neonatology, University of Louisville, Louisville, Kentucky, USA
| | - Wonik Lee
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Marc Collin
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Caroline Nguyen
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Suchitra Nelson
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Mena Nannig P, Cubillos Celis MP, Toro Jara C, Zuñiga Vergara C. Perfil bioquímico en sangre de cordón en prematuros extremos y crecimiento fetal. ACTA ACUST UNITED AC 2016; 87:250-4. [DOI: 10.1016/j.rchipe.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/28/2022]
|
3
|
Affiliation(s)
- E Mallet
- Département de pédiatrie médicale, CHU C.-Nicolle, 76000 Rouen, France.
| |
Collapse
|
4
|
Cholevas V, Challa A, Lapatsanis D, Andronikou S. Phosphate metabolism in the red cell of sick prematures. BONE AND MINERAL 1993; 22:177-85. [PMID: 8268751 DOI: 10.1016/s0169-6009(08)80066-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The effect of different amounts of phosphorus supplementation on phosphate metabolism was studied in two groups of sick preterms (B and C) during the first week of life. Group B included prematures that started formula milk feeding from day 3 and group C neonates on total parenteral nutrition with phosphate supplementation for 7 days. Twelve healthy preterm neonates on formula milk feeding from day 2 (group A) were used as controls. On the 7th day of life all phosphate parameters measured in group C (plasma and red cell inorganic phosphate and erythrocyte ATP and 2,3-diphosphoglycerate) were found significantly lower than in the controls (1.60 +/- 0.07; 0.60 +/- 0.08; 1.45 +/- 0.09 and 4.42 +/- 0.18 vs. 2.05 +/- 0.10; 0.94 +/- 0.11; 1.69 +/- 0.07 and 6.24 +/- 0.42 mmol/l, respectively). The renal tubular reabsorption of phosphate was also lower in this group (86.8 +/- 3.2 vs. 97.3 +/- 1.0%). No significant differences were observed between groups B and A. Higher phosphorus intake that was better achieved through early milk feeding prevented phosphate depletion and the decline of 2,3-diphosphoglycerate in the erythrocytes even of sick neonates which in turn might help to improve tissue oxygenation. The amount of parenteral phosphate supplementation that could have beneficial effects on red cell phosphate parameters needs further investigation.
Collapse
Affiliation(s)
- V Cholevas
- University of Ioannina, Child Health Department, Greece
| | | | | | | |
Collapse
|
5
|
Abstract
We examined the relationship between bone mineralization, measured by single photon absorptiometry, and blood phosphate and alkaline phosphatase concentration in 71 preterm neonates. Although both alkaline phosphatase and phosphate concentrations were significantly related to bone mineral content, and alkaline phosphatase concentrations were related to bone mineral content relative to weight, each could only explain a small amount of the variation in bone mineralization. Hence, concentrations of neither could be used to identify those neonates with the greatest bone mineral deficits.
Collapse
Affiliation(s)
- S W Ryan
- Institute of Child Health, University of Liverpool, UK
| | | | | | | |
Collapse
|
6
|
Draper HH, Yuen DE, Whyte RK. Calcium glycerophosphate as a source of calcium and phosphorus in total parenteral nutrition solutions. JPEN J Parenter Enteral Nutr 1991; 15:176-80. [PMID: 1904952 DOI: 10.1177/0148607191015002176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Calcium glycerophosphate (CaGP) was tested as an alternative to calcium gluconate (CaGluc) and potassium mono- and dibasic phosphate (KPhos) as a source of Ca and P in total parenteral nutrition (TPN) solutions for piglets. Four-day-old piglets were infused for 7 days with a TPN solution that provided either 4.2 mmol Ca and 2.1 mmol P/kg/24 h as CaGluc and KPhos (the maximum quantities that can be provided using these sources), or 15.0 mmol Ca and 15.0 mmol P/kg/24 h as CaGP. Ca and P retentions were more than six times greater (p less than 0.01) in the piglets receiving CaGP (14.5 +/- 0.2 vs 2.2 +/- 0.3 mmol Ca/kg/24 h and 13.3 +/- 0.4 vs 2.4 +/- 0.1 mmol P/kg/24 h) (Mean +/- SEM). The ratio of Ca to fat-free dry weight, an indicator of bone mineralization, was significantly higher (p less than 0.05) in the humerus (174.8 +/- 2.2 vs 147.2 +/- 6.7) and femur (158.3 +/- 4.8 vs 130.1 +/- 7.8) in the CaGP group. This study showed that CaGP is efficiently used as a source of Ca and P in TPN solutions for piglets. The results suggest that the use of CaGP as the source of Ca and P in TPN solutions may prevent the development of the undermineralized bone seen in low-birth weight infants nourished intravenously.
Collapse
Affiliation(s)
- H H Draper
- Department of Nutritional Sciences, University of Guelph, Ontario, Canada
| | | | | |
Collapse
|
7
|
Abstract
In a study on 857 infants born preterm, high peak plasma alkaline phosphatase activity was independently related to slower growth rate in the neonatal period, and to a highly significant reduction in attained length at 9 months and 18 months post term. At 18 months the deficit in body length associated with peak neonatal plasma alkaline phosphase activity of 1200 IU/l or more was 1.6 cm (95% confidence interval 0.9 to 2.3 cm) after adjusting for confounding factors. The strength and magnitude of this association between high plasma alkaline phosphase activity and body length was greater than that for any other factor identified, including the infant's sex and the presence of fetal growth retardation. Data are presented that support the view that the high plasma alkaline phosphatase activity reflected early bone mineral substrate deficiency resulting in metabolic bone disease. We speculate that even silent early bone disease may interfere with the control of subsequent linear growth and emphasise the potential importance of providing preterm infants, especially those fed human milk, with adequate substrate for bone mineralisation.
Collapse
Affiliation(s)
- A Lucas
- MRC Dunn Nutrition Unit, Cambridge
| | | | | | | | | |
Collapse
|
8
|
Aiken CG, Sherwood RA, Kenney IJ, Furnell M, Lenney W. Mineral balance studies in sick preterm intravenously fed infants during the first week after birth. A guide to fluid therapy. ACTA PAEDIATRICA SCANDINAVICA. SUPPLEMENT 1989; 355:1-59. [PMID: 2512760 DOI: 10.1111/j.1651-2227.1989.tb11232.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mineral balance studies were performed in 61 sick preterm infants given parenteral fluids only. Their gestational ages varied from 24 to 35 weeks, and 50 required mechanical ventilation. Two consecutive balance studies were performed; the first from admission to 48 hours in all babies given maintenance fluids of 10% Dextrose, and the second from 48 hours to 7 days in those babies given intravenous feeding (IVN). At the beginning and end of each balance period, the baby was weighed and an arterial blood sample taken for blood gases, electrolyte, urea, creatinine and protein determinations. During the balance period all urine was collected and analysed for electrolyte, urea, and creatinine composition, and all fluid intake was recorded. The balance of a mineral was calculated as the difference between parenteral intake and urine output. Infants requiring IVN were allocated alternatively to regimen X or regimen Y, which had the same calcium content of 9.5 mmol/L, but different phosphate contents, regimen X containing 7.3 mmol/L and regimen Y 11.6 mmol/L. In those infants requiring prolonged IVN, 12-24 hour balance studies were performed at weekly intervals after day 10. 1. Phosphate deficiency developed in infants given regimen X, who had higher urine calcium excretion, lower percentage calcium retention and lower plasma phosphate levels than those given regimen Y. These differences were apparent by day 7 and persisted after day 10. In infants given regimen Y, mean calcium retention from admission to day 7 was 3.9 mmol/kg, and after day 10 was 0.9 mmol/kg/day. 2. In the first 48 hours, urine output and creatinine clearance varied widely and were lower in infants with higher oxygen requirements at 48 hours. Ten babies had severe oliguria with outputs less than 10 mL/kg/day. Creatinine clearance was directly related to gestational age, mean arterial blood pressure, and plasma protein concentrations on admission. After 48 hours, urine output and creatinine clearance increased considerably. 3. In the first 48 hours, metabolic acidosis was produced by increased plasma non-protein metabolisable acid concentrations, which were associated with low creatinine clearances, and were thought to be due to lactic acid accumulation in response to decreased tissue perfusion. At 7 days, metabolic acidosis was of similar severity but was produced by decreased plasma non-metabolisable base concentrations, caused by increased urine loss of net base, and not directly by IVN.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- C G Aiken
- Trevor Mann Baby Unit, Royal Sussex County Hospital, Brighton, England
| | | | | | | | | |
Collapse
|
9
|
Abstract
Inadequate dietary phosphorus intake is a contributing factor to the occurrence of metabolic bone disease in very low birth weight infants. This article reviews the clinical presentation and the pathophysiology of the phosphorus deficiency syndrome in premature infants. Recommendations for therapy and prevention of phosphorus deficiency are presented.
Collapse
|
10
|
Abstract
Phosphorus intake was evaluated in 27 appropriate weight for gestational age, critically ill neonates who required total parenteral nutrition for 2 weeks. All received approximately 30 mg/kg/d elemental calcium. The low P intake group (1.01 mmol/kg/d, 30 mg/kg/d) showed signs of phosphate depletion: hypercalciuria, hypophosphatemia, and absence of phosphaturia. The high P intake group (1.67 mmol/kg/d, 50 mg/kg/d) did not have signs of P depletion; however, they had high urinary cyclic adenosine monophosphate excretion and marked phosphaturia, suggesting secondary hyperparathyroidism. The moderate P intake group (1.34 mmol/kg/d, 40 mg/kg/d) had evidence of neither phosphate depletion nor secondary hyperparathyroidism. This phosphorus dose appears to be appropriate for the very sick, poorly growing infant receiving total parenteral nutrition.
Collapse
|
11
|
Abstract
The stress response in humans commonly includes elevations in plasma concentrations of glucocorticoids, catecholamines, glucagon, growth hormone, aldosterone, and renin, resulting in alterations in the metabolism of glucose and other energy substrates, and in increased sodium and water retention. In severe illness, triiodothyronine and sometimes thyroxine are decreased without evidence of clinical hypothyroidism. Antidiuretic hormone may be elevated in bacterial meningitis and other central nervous system disorders, as well as in acute asthma, chronic ventilator therapy, pneumothorax, atelectasis, and postoperatively. Increased ADH concentration can lead to significant hypoosmolality and hyponatremia with adverse effects on the patient. In the setting of severe intracerebral insults, ADH may be inappropriately low, resulting in diabetes insipidus. Insulin concentrations may be inappropriately low for serum glucose concentration, or insulin may have diminished receptor responsiveness in seriously stressed patients. Either situation leads to hyperglycemia. Disturbances in calcium, phosphorus, and magnesium homeostasis may occur relatively frequently in the critically ill patient in response to therapeutic interventions, or illness-induced altered metabolism. It is not always clear when an altered metabolic or hormonal state is an appropriate response to a stress, or represents decompensation of the body's mechanisms for coping with that stress. It is important, however to recognize the common responses of the organism to severe illness, and to monitor for treatable abnormalities which occur.
Collapse
|
12
|
Carey DE, Goetz CA, Horak E, Rowe JC. Phosphorus wasting during phosphorus supplementation of human milk feedings in preterm infants. J Pediatr 1985; 107:790-4. [PMID: 4056982 DOI: 10.1016/s0022-3476(85)80419-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|