Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low‐Birth‐Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial
Background Refeeding syndrome (RS) following preterm birth has been linked to high intravenous (IV) protein intake in the presence of low electrolyte supply. In extremely low‐birth‐weight (ELBW) babies, we aimed to determine the incidence of RS and associations with birth characteristics and clinica...
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| Veröffentlicht in: | JPEN. Journal of parenteral and enteral nutrition 2021-01, Vol.45 (1), p.65-78 |
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| creator | Cormack, Barbara E. Jiang, Yannan Harding, Jane E. Crowther, Caroline A. Bloomfield, Frank H. |
| description | Background
Refeeding syndrome (RS) following preterm birth has been linked to high intravenous (IV) protein intake in the presence of low electrolyte supply. In extremely low‐birth‐weight (ELBW) babies, we aimed to determine the incidence of RS and associations with birth characteristics and clinical outcomes.
Method
Prospective cohort study of ELBW ProVIDe Trial participants in 6 New Zealand neonatal intensive care units. RS was defined as serum phosphate < 1.4 mmol.L−1 and total calcium > 2.8 mmol.L−1. Relationships between RS and other factors were explored using 2‐sample tests and logistic regression adjusted for sex, gestation, and birth‐weight z‐score.
Results
Of 338 babies (mean [SD] birth‐weight, 780 (134) g, gestational age, 25.9 [1.7] weeks), 68 (20%) had RS. Mortality was greater in babies with RS (32% vs 11%; P < .0001). More small‐ than appropriate‐for‐gestational‐age babies developed RS (22% vs 8%; P = .001). Growth from birth to 36 weeks’ corrected age was not different between babies who did and did not have RS. In logistic regression, the odds of RS decreased by 70% for each 1 mmol per kg−1.d−1 IV phosphate intake (odds ratio [OR], 0.3; CI, 0.1–0.6; P = .002) and increased by 80% for each 1 g.kg−1.d−1 IV protein intake (OR, 1.8; CI, 1.3–2.7; P = .002).
Conclusions
Neonatal RS is common in this cohort of ELBW babies and is associated with increased morbidity and mortality. Optimizing phosphate and calcium intakes in IV nutrition solutions may reduce RS and its consequences. |
| doi_str_mv | 10.1002/jpen.1934 |
| format | Article |
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Refeeding syndrome (RS) following preterm birth has been linked to high intravenous (IV) protein intake in the presence of low electrolyte supply. In extremely low‐birth‐weight (ELBW) babies, we aimed to determine the incidence of RS and associations with birth characteristics and clinical outcomes.
Method
Prospective cohort study of ELBW ProVIDe Trial participants in 6 New Zealand neonatal intensive care units. RS was defined as serum phosphate < 1.4 mmol.L−1 and total calcium > 2.8 mmol.L−1. Relationships between RS and other factors were explored using 2‐sample tests and logistic regression adjusted for sex, gestation, and birth‐weight z‐score.
Results
Of 338 babies (mean [SD] birth‐weight, 780 (134) g, gestational age, 25.9 [1.7] weeks), 68 (20%) had RS. Mortality was greater in babies with RS (32% vs 11%; P < .0001). More small‐ than appropriate‐for‐gestational‐age babies developed RS (22% vs 8%; P = .001). Growth from birth to 36 weeks’ corrected age was not different between babies who did and did not have RS. In logistic regression, the odds of RS decreased by 70% for each 1 mmol per kg−1.d−1 IV phosphate intake (odds ratio [OR], 0.3; CI, 0.1–0.6; P = .002) and increased by 80% for each 1 g.kg−1.d−1 IV protein intake (OR, 1.8; CI, 1.3–2.7; P = .002).
Conclusions
Neonatal RS is common in this cohort of ELBW babies and is associated with increased morbidity and mortality. Optimizing phosphate and calcium intakes in IV nutrition solutions may reduce RS and its consequences.</description><identifier>ISSN: 0148-6071</identifier><identifier>EISSN: 1941-2444</identifier><identifier>DOI: 10.1002/jpen.1934</identifier><identifier>PMID: 32458478</identifier><language>eng</language><publisher>United States: John Wiley and Sons Inc</publisher><subject>amino acids ; Cohort Studies ; Female ; fluids‐electrolytes/acid‐base ; Humans ; hypophosphatemia ; Infant ; Infant, Newborn ; intraventricular hemorrhage ; mortality ; neonates ; New Zealand - epidemiology ; Original Communication ; Original Communications ; parenteral nutrition ; Pregnancy ; Premature Birth ; preterm ; Prospective Studies ; proteins ; refeeding syndrome ; Refeeding Syndrome - epidemiology ; Refeeding Syndrome - etiology</subject><ispartof>JPEN. Journal of parenteral and enteral nutrition, 2021-01, Vol.45 (1), p.65-78</ispartof><rights>2020 The Authors. published by Wiley Periodicals, Inc. on behalf of American Society for Parenteral and Enteral Nutrition.</rights><rights>2020 The Authors. Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals, Inc. on behalf of American Society for Parenteral and Enteral Nutrition.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4154-8595825de9e7d98625e00a22f924f011a3424ae3f2d542732f647f7ca6dda06a3</citedby><cites>FETCH-LOGICAL-c4154-8595825de9e7d98625e00a22f924f011a3424ae3f2d542732f647f7ca6dda06a3</cites><orcidid>0000-0001-6424-6577 ; 0000-0002-7663-9164 ; 0000-0003-2697-1422 ; 0000-0003-2329-8287 ; 0000-0002-9079-4451</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjpen.1934$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjpen.1934$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32458478$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cormack, Barbara E.</creatorcontrib><creatorcontrib>Jiang, Yannan</creatorcontrib><creatorcontrib>Harding, Jane E.</creatorcontrib><creatorcontrib>Crowther, Caroline A.</creatorcontrib><creatorcontrib>Bloomfield, Frank H.</creatorcontrib><creatorcontrib>ProVIDe Trial Group</creatorcontrib><creatorcontrib>for the ProVIDe Trial Group</creatorcontrib><title>Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low‐Birth‐Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial</title><title>JPEN. Journal of parenteral and enteral nutrition</title><addtitle>JPEN J Parenter Enteral Nutr</addtitle><description>Background
Refeeding syndrome (RS) following preterm birth has been linked to high intravenous (IV) protein intake in the presence of low electrolyte supply. In extremely low‐birth‐weight (ELBW) babies, we aimed to determine the incidence of RS and associations with birth characteristics and clinical outcomes.
Method
Prospective cohort study of ELBW ProVIDe Trial participants in 6 New Zealand neonatal intensive care units. RS was defined as serum phosphate < 1.4 mmol.L−1 and total calcium > 2.8 mmol.L−1. Relationships between RS and other factors were explored using 2‐sample tests and logistic regression adjusted for sex, gestation, and birth‐weight z‐score.
Results
Of 338 babies (mean [SD] birth‐weight, 780 (134) g, gestational age, 25.9 [1.7] weeks), 68 (20%) had RS. Mortality was greater in babies with RS (32% vs 11%; P < .0001). More small‐ than appropriate‐for‐gestational‐age babies developed RS (22% vs 8%; P = .001). Growth from birth to 36 weeks’ corrected age was not different between babies who did and did not have RS. In logistic regression, the odds of RS decreased by 70% for each 1 mmol per kg−1.d−1 IV phosphate intake (odds ratio [OR], 0.3; CI, 0.1–0.6; P = .002) and increased by 80% for each 1 g.kg−1.d−1 IV protein intake (OR, 1.8; CI, 1.3–2.7; P = .002).
Conclusions
Neonatal RS is common in this cohort of ELBW babies and is associated with increased morbidity and mortality. Optimizing phosphate and calcium intakes in IV nutrition solutions may reduce RS and its consequences.</description><subject>amino acids</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>fluids‐electrolytes/acid‐base</subject><subject>Humans</subject><subject>hypophosphatemia</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>intraventricular hemorrhage</subject><subject>mortality</subject><subject>neonates</subject><subject>New Zealand - epidemiology</subject><subject>Original Communication</subject><subject>Original Communications</subject><subject>parenteral nutrition</subject><subject>Pregnancy</subject><subject>Premature Birth</subject><subject>preterm</subject><subject>Prospective Studies</subject><subject>proteins</subject><subject>refeeding syndrome</subject><subject>Refeeding Syndrome - epidemiology</subject><subject>Refeeding Syndrome - etiology</subject><issn>0148-6071</issn><issn>1941-2444</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc1u1DAURi0EokNhwQsgL2GR1n-JExZI7TCFolFb0QJLy41vJq4ce7AzbbNjz4Zn5ElImFLBgtWV7nd07pU-hJ5TskcJYftXa_B7tOLiAZrRStCMCSEeohmhoswKIukOepLSFSGEF4Q8RjucibwUspyh7ycQvO61wx-hATDWr_D54E0MHWDtDZ4762095qebvp6W1uPFbR-hAzfgZbj5-e3HoY19O84vYFdtjw_1pYX0Gp9DHbzRccDz0IbY4wOv3ZBswkejHvct4LMYPh-_BXwRrXZP0aNGuwTP7uYu-nS0uJi_z5an747nB8usFjQXWZlXeclyAxVIU5UFy4EQzVhTMdEQSjUXTGjgDTO5YJKzphCykbUujNGk0HwXvdl615vLDkwNvo_aqXW03fisCtqqfxNvW7UK10qWFeW8GAUv7wQxfN1A6lVnUw3OaQ9hkxQTRHIqZDGhr7ZoHUNKEZr7M5SoqTw1laem8kb2xd9_3ZN_2hqB_S1wYx0M_zepD2eLk9_KXzqvqBs</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Cormack, Barbara E.</creator><creator>Jiang, Yannan</creator><creator>Harding, Jane E.</creator><creator>Crowther, Caroline A.</creator><creator>Bloomfield, Frank H.</creator><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6424-6577</orcidid><orcidid>https://orcid.org/0000-0002-7663-9164</orcidid><orcidid>https://orcid.org/0000-0003-2697-1422</orcidid><orcidid>https://orcid.org/0000-0003-2329-8287</orcidid><orcidid>https://orcid.org/0000-0002-9079-4451</orcidid></search><sort><creationdate>202101</creationdate><title>Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low‐Birth‐Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial</title><author>Cormack, Barbara E. ; Jiang, Yannan ; Harding, Jane E. ; Crowther, Caroline A. ; Bloomfield, Frank H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4154-8595825de9e7d98625e00a22f924f011a3424ae3f2d542732f647f7ca6dda06a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>amino acids</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>fluids‐electrolytes/acid‐base</topic><topic>Humans</topic><topic>hypophosphatemia</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>intraventricular hemorrhage</topic><topic>mortality</topic><topic>neonates</topic><topic>New Zealand - epidemiology</topic><topic>Original Communication</topic><topic>Original Communications</topic><topic>parenteral nutrition</topic><topic>Pregnancy</topic><topic>Premature Birth</topic><topic>preterm</topic><topic>Prospective Studies</topic><topic>proteins</topic><topic>refeeding syndrome</topic><topic>Refeeding Syndrome - epidemiology</topic><topic>Refeeding Syndrome - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cormack, Barbara E.</creatorcontrib><creatorcontrib>Jiang, Yannan</creatorcontrib><creatorcontrib>Harding, Jane E.</creatorcontrib><creatorcontrib>Crowther, Caroline A.</creatorcontrib><creatorcontrib>Bloomfield, Frank H.</creatorcontrib><creatorcontrib>ProVIDe Trial Group</creatorcontrib><creatorcontrib>for the ProVIDe Trial Group</creatorcontrib><collection>Wiley Open Access Journals</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JPEN. Journal of parenteral and enteral nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cormack, Barbara E.</au><au>Jiang, Yannan</au><au>Harding, Jane E.</au><au>Crowther, Caroline A.</au><au>Bloomfield, Frank H.</au><aucorp>ProVIDe Trial Group</aucorp><aucorp>for the ProVIDe Trial Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low‐Birth‐Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial</atitle><jtitle>JPEN. Journal of parenteral and enteral nutrition</jtitle><addtitle>JPEN J Parenter Enteral Nutr</addtitle><date>2021-01</date><risdate>2021</risdate><volume>45</volume><issue>1</issue><spage>65</spage><epage>78</epage><pages>65-78</pages><issn>0148-6071</issn><eissn>1941-2444</eissn><abstract>Background
Refeeding syndrome (RS) following preterm birth has been linked to high intravenous (IV) protein intake in the presence of low electrolyte supply. In extremely low‐birth‐weight (ELBW) babies, we aimed to determine the incidence of RS and associations with birth characteristics and clinical outcomes.
Method
Prospective cohort study of ELBW ProVIDe Trial participants in 6 New Zealand neonatal intensive care units. RS was defined as serum phosphate < 1.4 mmol.L−1 and total calcium > 2.8 mmol.L−1. Relationships between RS and other factors were explored using 2‐sample tests and logistic regression adjusted for sex, gestation, and birth‐weight z‐score.
Results
Of 338 babies (mean [SD] birth‐weight, 780 (134) g, gestational age, 25.9 [1.7] weeks), 68 (20%) had RS. Mortality was greater in babies with RS (32% vs 11%; P < .0001). More small‐ than appropriate‐for‐gestational‐age babies developed RS (22% vs 8%; P = .001). Growth from birth to 36 weeks’ corrected age was not different between babies who did and did not have RS. In logistic regression, the odds of RS decreased by 70% for each 1 mmol per kg−1.d−1 IV phosphate intake (odds ratio [OR], 0.3; CI, 0.1–0.6; P = .002) and increased by 80% for each 1 g.kg−1.d−1 IV protein intake (OR, 1.8; CI, 1.3–2.7; P = .002).
Conclusions
Neonatal RS is common in this cohort of ELBW babies and is associated with increased morbidity and mortality. Optimizing phosphate and calcium intakes in IV nutrition solutions may reduce RS and its consequences.</abstract><cop>United States</cop><pub>John Wiley and Sons Inc</pub><pmid>32458478</pmid><doi>10.1002/jpen.1934</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0001-6424-6577</orcidid><orcidid>https://orcid.org/0000-0002-7663-9164</orcidid><orcidid>https://orcid.org/0000-0003-2697-1422</orcidid><orcidid>https://orcid.org/0000-0003-2329-8287</orcidid><orcidid>https://orcid.org/0000-0002-9079-4451</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | amino acids Cohort Studies Female fluids‐electrolytes/acid‐base Humans hypophosphatemia Infant Infant, Newborn intraventricular hemorrhage mortality neonates New Zealand - epidemiology Original Communication Original Communications parenteral nutrition Pregnancy Premature Birth preterm Prospective Studies proteins refeeding syndrome Refeeding Syndrome - epidemiology Refeeding Syndrome - etiology |
| title | Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low‐Birth‐Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial |
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