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Calcium and Phosphorus Intake by Parenteral Nutrition in Preterm Infants

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Diet and Nutrition in Critical Care

Abstract

Very premature infants are at an increased risk for metabolic bone disease because they forego the last trimester of pregnancy, the period of greatest mineral accretion. Most of these infants cannot tolerate full enteral feedings within the first postnatal days or weeks, and nutrients including calcium and phosphorus need to be delivered by parenteral nutrition. The ongoing challenges for bone nutrition in preterm infants involve not only guaranteeing high concentrations of calcium and phosphorus in parenteral nutrition admixtures while maintaining their compatibility but also achieving an optimal skeletal mineralization with the large amounts of minerals delivered. The main factors promoting calcium and phosphorus compatibility in parenteral nutrition admixtures include low final pH and temperature to produce more monobasic phosphate, use of organic calcium and P salts, and final high amino acid concentration with the inclusion of cysteine.

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References

  • Abrams SA. In utero physiology: role in nutrient delivery and fetal development for calcium, phosphorus, and vitamin D. Am J Clin Nutr. 2007;85:604S–7S.

    CAS  PubMed  Google Scholar 

  • Allwood MC, Kearney MC. Compatibility and stability of additives in parenteral nutrition admixtures. Nutrition. 1998;14:697–706.

    Article  CAS  PubMed  Google Scholar 

  • Atkinson SA, Tsang RC. Calcium, magnesium, phosphorus and vitamin D. In: Tsang RC, Uauy R, Zlotkin SH, Koletzko B, editors. Nutrition of the preterm infant. Cincinnati, Ohio: Digital Educational Publishing, Inc.; 2005. p. 245–75.

    Google Scholar 

  • Bouchoud L, Fonzo-Christe C, Sadeghipour F, et al. Maximizing calcium and phosphate content in neonatal parenteral nutrition solutions using organic calcium and phosphate salts. JPEN J Parenter Enteral Nutr. 2010;34:542–45.

    Article  CAS  PubMed  Google Scholar 

  • Boullata JI, Gilbert K, Sacks G, Labossiere RJ, Crill C, Goday P, Kumpf VJ, Mattox TW, Plogsted S, Holcombe B, American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. Clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. JPEN J Parenter Enteral Nutr. 2014;38:334–77.

    Article  PubMed  Google Scholar 

  • Bozzetti V, Tagliabue P. Metabolic bone disease in preterm newborn: an update on nutritional issues. Ital J Pediatr. 2009;35:20.

    Article  PubMed Central  PubMed  Google Scholar 

  • Chaieb SD, Chaumeil JC, Jebnoun S, et al. Calcium and phosphate compatibility and stability studies in different neonatal parenteral nutrition mixtures. Eur J Hosp Pharm Sci. 2006;12:35–40.

    Google Scholar 

  • Chaieb SD, Chaumeil JC, Jebnoun S, et al. Effect of high calcium and phosphate concentrations on the physicochemical properties of two lipid emulsions used as total parenteral nutrition for neonates. PDA J Pharm Sci Technol. 2009;63:27–41.

    CAS  PubMed  Google Scholar 

  • Cole DE, Zlotkin SH. Increased sulfate as an etiological factor in the hypercalciuria associated with total parenteral nutrition. Am J Clin Nutr. 1983;37:108–13.

    CAS  PubMed  Google Scholar 

  • Doellman D, Hadawa L, Bowe-Geddes LA, et al. Infiltration and extravasation: update on prevention and management. J Infus Nurs. 2009;32:203–11.

    Article  PubMed  Google Scholar 

  • Driscoll DF. Compounding TPN admixtures: then and now. JPEN J Parenter Enteral Nutr. 2003;27:433–38.

    Article  CAS  PubMed  Google Scholar 

  • Eggert LD, Rusho WJ, MacKay MW, et al. Calcium and phosphorus compatibility in parental nutrition solutions for neonates. Am J Hosp Pharm. 1982;39:49–53.

    CAS  PubMed  Google Scholar 

  • ElHassan NO, Kaiser JR. Parenteral nutrition in the neonatal intensive care unit. NeoReviews. 2011;12:e130–40.

    Article  Google Scholar 

  • Fitzgerald KA, MacKay MW. Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing TrophAmine. Am J Hosp Pharm. 1986;43:88–93.

    CAS  PubMed  Google Scholar 

  • Gura KM. Is there still a role for peripheral parenteral nutrition? Nutr Clin Pract. 2009;24:709–17.

    Article  PubMed  Google Scholar 

  • Hanning RM, Atkinson SA, Whyte RK. Efficacy of calcium glycerophosphate vs conventional mineral salts for total parenteral nutrition in low-birth-weight infants: a randomized clinical trial. Am J Clin Nutr. 1991;54:903–8.

    CAS  PubMed  Google Scholar 

  • Harrison CM, Gibson AT. Osteopenia in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2013;98:F272–75.

    Article  PubMed  Google Scholar 

  • Joy J, Silvestri AP, Franke R, et al. Calcium and phosphate compatibility in low-osmolarity parenteral nutrition admixtures intended for peripheral vein administration. JPEN J Parenter Enteral Nutr. 2010;34:46–54.

    Article  CAS  PubMed  Google Scholar 

  • Koletzko B, Goulet O, Hunt J, et al. Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005;41 Suppl 2:S1–87.

    Article  PubMed  Google Scholar 

  • Litmanovitz I, Dolfin T, Friedland O, et al. Early physical activity intervention prevents decrease of bone strength in very low birth weight infants. Pediatrics. 2003;112(1 Pt 1):15–9.

    Article  PubMed  Google Scholar 

  • Magno AL, Ward BK, Ratajczak T. The calcium-sensing receptor: a molecular perspective. Endocr Rev. 2011;32:3–30.

    Article  CAS  PubMed  Google Scholar 

  • Migaki EA, Melhart BJ, Dewar CJ, et al. Calcium chloride and sodium phosphate in neonatal parenteral nutrition containing TrophAmine: precipitation studies and aluminum content. JPEN J Parenter Enteral Nutr. 2012;36:470–75.

    Article  CAS  PubMed  Google Scholar 

  • Mirtallo JM. Complications associated with drug and nutrient interactions. J Infus Nurs. 2004;27:19–24.

    Article  PubMed  Google Scholar 

  • Mirtallo J, Canada T, Johnson D, et al. Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr. 2004;28:S39–70.

    Article  PubMed  Google Scholar 

  • Nehra D, Carlson SJ, Fallon EM, et al. A.S.P.E.N. Clinical guidelines: nutrition support of neonatal patients at risk for metabolic bone disease. JPEN J Parenter Enteral Nutr. 2013;37(5):570–98.

    Article  PubMed  Google Scholar 

  • Newton DW, Driscoll DF. Calcium and phosphate compatibility: revisited again. Am J Health Syst Pharm. 2008a;65:73–80.

    Article  CAS  PubMed  Google Scholar 

  • Newton DW, Driscoll DF. Chemistry and safety of phosphates injections. Am J Health Syst Pharm. 2008b;65:1761–66.

    Article  CAS  PubMed  Google Scholar 

  • Niemiec Jr PW, Vanderveen TW. Compatibility considerations in parenteral nutrient solutions. Am J Hosp Pharm. 1984;41:893–911.

    CAS  PubMed  Google Scholar 

  • Pelegano JF, Rowe JC, Carey DE, et al. Effect of calcium/phosphorus ratio on mineral retention in parenterally fed premature infants. J Pediatr Gastroenterol Nutr. 1991;12:351–55.

    Article  CAS  PubMed  Google Scholar 

  • Pereira-da-Silva L, Nurmamodo A, Amaral JM, et al. Compatibility of calcium and phosphate in four parenteral nutrition solutions for preterm neonates. Am J Health Syst Pharm. 2003;60:1041–44.

    CAS  PubMed  Google Scholar 

  • Pereira-da-Silva L, Virella D, Henriques G, et al. A simple equation to estimate the osmolarity of neonatal parenteral nutrition solutions. JPEN J Parenter Enteral Nutr. 2004;28:34–7.

    Article  CAS  PubMed  Google Scholar 

  • Pereira-da-Silva L, Costa A, Pereira L, et al. Early high calcium and phosphorus intake by parenteral nutrition prevents short-term bone strength decline in preterm infants. J Pediatr Gastroenterol Nutr. 2011;52:203–9.

    Article  CAS  PubMed  Google Scholar 

  • Prestridge LL, Schanler RJ, Shulman RJ, et al. Effect of parenteral calcium and phosphorus therapy on mineral retention and bone mineral content in very low birth weight infants. J Pediatr. 1993;122(5 Pt 1):761–68.

    Article  CAS  PubMed  Google Scholar 

  • Prinzivalli M, Ceccarelli S. Sodium d-fructose-1,6-diphosphate vs. sodium monohydrogen phosphate in total parenteral nutrition: a comparative in vitro assessment of calcium phosphate compatibility. JPEN J Parenter Enteral Nutr. 1999;23:326–32.

    Article  CAS  PubMed  Google Scholar 

  • Rauch F, Schoenau E. Skeletal development in premature infants: a review of bone physiology beyond nutritional aspects. Arch Dis Child Fetal Neonatal Ed. 2002;86:F82–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Ribeiro DO, Lobo BW, Volpato NM, et al. 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. Nutr J. 2009;8:51.

    Article  PubMed Central  Google Scholar 

  • Rigo J, Mohamed MW, De Curtis M. Disorders of calcium, phosphorus and magnesium metabolism. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff & Martin’s neonatal perinatal medicine: diseases of the fetus and infant. Missouri: Elsevier Mosby; 2011. p. 1523–56.

    Google Scholar 

  • Singh H, Dumas GJ, Silvestri AP, et al. Physical compatibility of neonatal total parenteral nutrition admixtures containing organic calcium and inorganic phosphate salts in a simulated infusion at 37 degrees C. Pediatr Crit Care Med. 2009;10:213–16.

    Article  PubMed  Google Scholar 

  • Thompson JS, Rochling FA, Weseman RA, et al. Current management of short bowel syndrome. Curr Probl Surg. 2012;49:52–115.

    Article  PubMed  Google Scholar 

  • Vachharajani AJ, Mathur AM, Rao R. Metabolic bone disease of prematurity. NeoReviews. 2009;10:e402–11.

    Article  Google Scholar 

  • Visser F, Sprij AJ, Brus F. The validity of biochemical markers in metabolic bone disease in preterm infants: a systematic review. Acta Paediatr. 2012;101:562–68.

    Article  CAS  PubMed  Google Scholar 

  • Wong JC, McDougal AR, Tofan M, et al. Doubling calcium and phosphate concentrations in neonatal parenteral nutrition solutions using monobasic potassium phosphate. J Am Coll Nutr. 2006;25:70–7.

    Article  CAS  PubMed  Google Scholar 

  • Wongpoowarak W, Apiromrak B, Wongpoowarak P, et al. Physicochemical transfer functions to predict zone of precipitation between calcium and phosphate in simplified parenteral nutrition. J Appl Pharm Sci. 2011;2:6–14.

    Google Scholar 

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Author information

Authors and Affiliations

  1. NOVA Medical School, Lisbon, Portugal

    Luis Pereira-da-Silva

  2. NICU, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Rua Jacinta Marto, 1069-045, Lisbon, Portugal

    Luis Pereira-da-Silva

  3. NICU, Maternidade Dr. Alfredo da Costa, Centro Hospitalar de Lisboa Central, Rua Viriato, 1069-089, Lisbon, Portugal

    Israel Macedo

  4. Pharmacy Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Rua Jacinta Marto, 1069-045, Lisbon, Portugal

    Maria Luísa Rosa

  5. Neonatal Intensive Care Unit, St. John Providence Children’s Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA

    Kayla M. Bridges

Authors
  1. Luis Pereira-da-Silva
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  2. Israel Macedo
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  3. Maria Luísa Rosa
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  4. Kayla M. Bridges
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Corresponding author

Correspondence to Luis Pereira-da-Silva .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Pereira-da-Silva, L., Macedo, I., Rosa, M.L., Bridges, K.M. (2014). Calcium and Phosphorus Intake by Parenteral Nutrition in Preterm Infants. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_68-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_68-1

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  • Publisher Name: Springer, New York, NY

  • Online ISBN: 978-1-4614-8503-2

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