Does Adding Intravenous Phosphorus to Parenteral Nutrition Has Any Effects on Calcium and Phosphorus Metabolism and Bone Mineral Content in Preterm Neonates?
AbstractThe use of parenteral nutritional supplementation of phosphorus may lead to exhibit higher plasma phosphate concentrations and less radiological features in premature neonates susceptible to osteopenia. The present study aimed to assess the beneficial effects of adding intravenous phosphorus to total parenteral nutrition (TPN) on calcium and phosphorus metabolism in preterm neonates by measuring bone mineral content. This open-labeled randomized clinical trial was conducted on premature neonates who were hospitalized at NICU. The neonates were randomly assigned to two groups received TPN with intravenous sodium glycerophosphate or Glycophos (1.5 mmol/kg/day) or TPN without sodium glycerophosphate. At the end of the four weeks of treatment, the presence of osteopenia was examined using DEXA Scan. After completing treatment protocols, the group received TPN with intravenous Glycophos had significantly lower serum alkaline phosphatase (360±60 versus 762±71, P<0.001), as well as higher serum calcium to creatinine ratio (1.6±0.3 versus 0.44±0.13, P<0.001) compared to the control group received TPN without Glycophos. Those who received TPN with intravenous Glycophos experienced more increase in bone mineral density than those in control group (0.13±0.01 versus 0.10±0.02, P<0.001). There was no significant difference in serum calcium and serum vitamin D between the case and control groups. Adding intravenous sodium glycerophosphate to TPN in premature neonates can compensate the lack of bone mineral content and help to prevent osteopenia.
Pitkin RM, Reynolds WA, Williams GA, Hargis GK. Calcium metabolism in normal pregnancy: a longitudinal study. Am J Obstet Gynecol. 1979; 133:781-90.
Heaney RP, Skillman TG. Calcium metabolism in normal human pregnancy. J Clin Endocrinol Metab. 1971;33:661-70.
Park W, Paust H, Kaufmann HJ, Offermann G. Osteomalacia of the mother--rickets of the newborn. Eur J Pediatr. 1987;146:292-3.
Yeh JK, Liu CC, Aloia JF. Effects of exercise and immobilization on bone formation and resorption in young rats. Am J Physiol. 1993;264:182-9.
Eliakim A, Nemet D, Friedland O, Dolfin T, Regev RH. Spontaneous activity in premature infants affects bone strength. J Perinatol. 2002;22:650-2.
Moyer-Mileur L, Luetkemeier M, Boomer L, Chan GM. Effect of physical activity on bone mineralization in premature infants. J Pediatr. 1995;127:620-5.
Maas C, Pohlandt F, Mihatsch WA, Franz AR. Prevention of bone mineral deficiency in premature infants: review of the literature with focus on monitoring of urinary calcium and phosphate]. Klin Padiatr. 2012;224:80-7.
Viswanathan S, Khasawneh W, McNelis K, Dykstra C, Amstadt R, Super DM, Groh-Wargo S, Kumar D. Metabolic bone disease: a continued challenge in extremely low birth weight infants. JPEN J Parenter Enteral Nutr. 2014;38:982-90.
Gortner L. Osteopenia of prematurity - a current problem?. Klin Padiatr. 2012;224:51-2
Weiler HA, Wang Z, Atkinson SA. Dexamethasone treatment impairs calcium regulation and reduces bone mineralization in infant pigs. Am J Clin Nutr. 1995;61:805-11
Wesół-Kucharska D1, Laskowska J, Sibilska M, Friedman-Gruszczyńska J, Błońska M, Gawecka A, Czech-Kowalska J, Dobrzańska A, Ksiazyk J, Swietliński J. Prevention of osteopenia in premature infants. Med Wieku Rozwoj. 2008;12:924-32.
Aroor AR, Krishnan L, Reyes Z, Fazallulah M, Ahmed M, Khan AA, Al-Farsi Y. Early versus Late Parenteral Nutrition in Very Low Birthweight Neonates: A retrospective study from Oman. Sultan Qaboos Univ Med J. 2012;12:33-40.
Colonna F1, Candusso M, de Vonderweid U, Marinoni S, Gazzola AM. Calcium and phosphorus balance in very low birth weight babies on total parenteral nutrition. Clin Nutr. 1990;9:89-95.
Awad HA1, Farid TM, Khafagy SM, Nofal RI. Bone mineral content measured by DEXA scan in preterm neonates receiving total parentral nutrition with and without phosphorus supplementation. Pak J Biol Sci. 2010;13:891-5.
Prestridge LL1, Schanler RJ, Shulman RJ, Burns PA, Laine LL. Effect of parenteral calcium and phosphorus therapy on mineral retention and bone mineral content in very low birth weight infants. J Pediatr. 1993;122:761-8.
Pelegano JF1, Rowe JC, Carey DE, LaBarre DJ, Edgren KW, Lazar AM, Horak E Effect of calcium/phosphorus ratio on mineral retention in parenterally fed premature infants. J Pediatr Gastroenterol Nutr. 1991;12:351-5.
Hettrich B1, Kalhoff H, Rudloff S, Diekmann L, Stock GJ, Manz F. Supplementation of premature infant nutrition with calcium and phosphor for improving mineral supply of premature and small-for-gestational age newborn infants. Klin Padiatr. 1995;207:334-40.
Kimura S, Nose O, Seino Y, Harada T, Kanaya S, Yabuuchi H, Itakura T, Takagi Y, Okada A. Effects of alternate and simultaneous administrations of calcium and phosphorus on calcium metabolism in children receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr. 1986;10:513-6.
Draper HH1, Yuen DE, Whyte RK. Calcium glycerophosphate as a source of calcium and phosphorus in total parenteral nutrition solutions. JPEN J Parenter Enteral Nutr. 1991;15:176-80.
Raupp P1, von Kries R, Pfahl HG, Manz F. Glycero-vs glucose-phosphate in parenteral nutrition of premature infants: a comparative in vitro evaluation of calcium/phosphorus compatibility. JPEN J Parenter Enteral Nutr. 1991;15:469-73.