Influence of the calcium concentration in the presence of organic phosphorus on the physicochemical compatibility and stability of all-in-one admixtures for neonatal use.
BACKGROUND
Preterm infants need high amounts of calcium and phosphorus for bone mineralization, which is difficult to obtain with parenteral feeding due to the low solubility of these salts. The objective of this study was to evaluate the physicochemical compatibility of high concentrations of calcium associated with organic phosphate and its influence on the stability of AIO admixtures for neonatal use.


METHODS
Three TPN admixture formulas were prepared in multilayered bags. The calcium content of the admixtures was adjusted to 0, 46.5 or 93 mg/100 ml in the presence of a fixed organic phosphate concentration as well as lipids, amino acids, inorganic salts, glucose, vitamins and oligoelements at pH 5.5. Each admixture was stored at 4 degrees C, 25 degrees C or 37 degrees C and evaluated over a period of 7 days. The physicochemical stability parameters evaluated were visual aspect, pH, sterility, osmolality, peroxide formation, precipitation, and the size of lipid globules.


RESULTS
Color alterations occurred from the first day on, and reversible lipid film formation from the third day of study for the admixtures stored at 25 degrees C and 37 degrees C. According to the parameters evaluated, the admixtures were stable at 4 degrees C; and none of them presented precipitated particles due to calcium/phosphate incompatibility or lipid globules larger than 5 mum, which is the main parameter currently used to evaluate lipid emulsion stability. The admixtures maintained low peroxide levels and osmolarity was appropriate for parenteral administration.


CONCLUSIONS
The total calcium and calcium/phosphorus ratios studied appeared not to influence the physicochemical compatibility and stability of AIO admixtures.
Departamento de Medicamentos, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, CCS, Rio de Janeiro, RJ, Brazil. daniriboliveira@yahoo.com.br
Daniela de Oliveira
Dde O
Ribeiro
Bianca Waruar
BW
Lobo
Nádia Maria
NM
Volpato
Venício Féo
VF
da Veiga
Lúcio Mendes
LM
Cabral
Valeria Pereira
VP
de Sousa
D002118:Calcium / Q000737:chemistry*; D002136:Calcium, Dietary / Q000008:administration & dosage*; D011232:Chemical Precipitation; D003080:Cold Temperature; D005217:Fat Emulsions, Intravenous / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D015227:Lipid Peroxidation; D009943:Organophosphorus Compounds / Q000737:chemistry*; D009994:Osmolar Concentration; D010289:Parenteral Nutrition, Total; D010316:Particle Size; D016226:Phosphorus, Dietary / Q000008:administration & dosage*; D010858:Pigmentation; D013242:Sterilization; D013997:Time Factors
D002136:Calcium, Dietary; D005217:Fat Emulsions, Intravenous; D009943:Organophosphorus Compounds; D016226:Phosphorus, Dietary; D002118:Calcium