Hypophosphatemia in premature infants: screening and clinical aspects

• Liaisan M. Mullakhmetova
• Anton D. Yuditskiy
• Tatiana V. Kovalenko
• Natalia N. Popova
• Dmitry N. Degtyarev

Abstract

Current area of research is the study of a risk factors, formation of mechanisms, and clinical features of hypophosphatemia in premature infants in order to develop new approaches to screening, prevention and the early correction.

Aim. To study the clinical aspects of hypophosphatemia in very premature infants.

Material and methods. The study included premature infants of gestational age 24/0–31/6 weeks (n=84). The subjects were divided into an observation group (n=49; 58.3%) and a comparison group (n=35; 41.7%). The main criterion for inclusion in the observation group was hypophosphatemia – serum phosphorus concentration ≤4.5 mg/dL (≤1.45 mmol/L). The comparison group included premature infants with serum phosphorus concentrations higher than the specified values. Laboratory monitoring of phosphorus-calcium metabolism indicators in dynamics was carried out at the age of 6–8 and 9–12 weeks of life. When the enteral nutrition was performed, the intake of calcium (mg/kg/day), phosphorus (mg/kg/day) and vitamin D (IU/kg/day) calculated on days 14, 28 and 42 of life. Statistical processing of the material was performed using non-parametric criteria. Differences were considered statistically significant at p<0.05.

Results. In the group of premature infants with hypophosphatemia, a long duration of parenteral nutrition was observed – 44.0 (36.5–52.5) days (p=0.010), low enteral supplementation of minerals and the need for prolonged respiratory support – 11.0 (6.8–26.3) days (p=0.049). Necrotizing enterocolitis was significantly more often diagnosed in the observation group (26.5% compared to 5.7%, p=0.015). The severe condition of the children in the observation group required a longer stay in the Perinatal Center – 67.0 (57.0–74.0) days [in the comparison group – 58.0 (45.3–69.5) days, p=0.023]. During X-ray examination at 6–8 weeks of life, signs of damage to the bone system characteristic of metabolic bone disease were observed only in children of the observation group – in 30.0% of those examined by X-ray methods.

Conclusion. The most significant clinical aspects identified in premature infants with hypophosphatemia are long-term parenteral nutrition and low enteral supplementation of minerals, due to decreased tolerance to enteral load, the nature and severity of the pathology, among which necrotizing enterocolitis and early neonatal sepsis play pivotal role. Radiological signs of metabolic bone damage at the age of 6–8 weeks were observed in 30.0% of premature infants with hypophosphatemia.

Keywords:preterm infants; hypophosphatemia; screening; metabolic bone disease

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