title: Electrolyte and Mineral Homeostasis After Optimizing Early Macronutrient Intakes in VLBW Infants on Parenteral Nutrition.
abstract: OBJECTIVE
  The aim of the present study was to evaluate electrolyte and mineral homeostasis in very-low-birth-weight (VLBW) infants who received high protein and energy intakes with a unique standardized parenteral nutrition solution containing electrolytes and minerals from birth onward.
  
  
  METHODS
  Prospective cohort study in 102 infants with birth weight <1250 g. The evolution of plasma biochemical parameters was described during the first 2 weeks of life.
  
  
  RESULTS
  During the first 3 days of life, mean parenteral intakes were 51 ± 8 kcal · kg · day with 2.7 ± 0.4 g · kg · day of protein, 1.1 ± 0.2 mmol · kg · day of sodium and potassium, and 1.3 ± 0.2 mmol · kg · day of calcium and phosphorus. Afterwards, most nutritional intakes (parenteral and enteral) met growth requirements. No infant developed a hyperkalemia >7 mmol/L, and a hypernatremia >150 mmol/L occurred only in 15.7% of the infants. In contrast, hyponatremia <130 mmol/L and hypokalemia <3 mmol/L occurred in 30.4% and 8.8% of the infants, respectively. The initial neonatal metabolic acidosis rapidly resolved in most infants and only 2.0% developed a base deficit >10 mmol/L after day 3 of life. Early hypocalcemia <1.8 mmol/L occurred in 13.7% of the infants. In contrast, hypophosphatemia <1.6 mmol/L occurred in 37.3% and hypercalcemia >2.8 mmol/L occurred in 12.7% of the infants.
  
  
  CONCLUSIONS
  Increasing early protein and energy intakes in VLBW infants in the first week of life improves electrolyte homeostasis. It also increases the phosphorus requirements with a calcium-to-phosphorus ratio ≤1.0 (mmol/mmol) and the potassium and sodium requirements to avoid the development of a refeeding-like syndrome. These data suggest that the parenteral nutrition guidelines for VLBW infants for the first week of life need to be revised.
authors.affiliation: Department of Neonatology, University of Liège, CHU de Liège, CHR de la Citadelle, Liège, Belgium.
authors.forename: Thibault
authors.initials: T
authors.lastname: Senterre
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abu Zahirah
authors.forename: Catherine
authors.initials: C
authors.lastname: Pieltain
authors.forename: Virginie
authors.initials: V
authors.lastname: de Halleux
authors.forename: Jacques
authors.initials: J
authors.lastname: Rigo
mesh_terms: D000138:Acidosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D001530:Belgium; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition; D006785:Hospitals, University; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D009751:Nutritional Requirements; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010758:Phosphorus / Q000008:administration & dosage / Q000627:therapeutic use*; D011188:Potassium / Q000008:administration & dosage / Q000627:therapeutic use*; D047928:Premature Birth / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012964:Sodium / Q000008:administration & dosage / Q000627:therapeutic use*; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000517:prevention & control*
chemical_list: D004044:Dietary Proteins; D010758:Phosphorus; D012964:Sodium; D011188:Potassium; D002118:Calcium