Impact of an updated electrolytic supply protocol in hydroelectrolytic disorders in very preterm infants receiving optimized parenteral nutrition: a historical cohort study

Abstract

Background: In the last years recent guidelines of parenteral nutrition for very preterm infants recommend a higher and earlier intake of amino acids (AA) and energy to avoid postnatal catabolism, with the goal of mimicking the AA dose that the foetus would receive in utero. However, this new approach can be associated with important metabolic disturbances in the first days of life, particularly influencing the metabolism of potassium, phosphorus and calcium. When phosphorus is taken up by cells, without being adequately provided by the administered nutrition, the level in blood falls. The majority of body phosphate and calcium are located together in the skeleton, and the two minerals are tightly connected to each other, when plasma phosphate levels drop, an increase in bone resorption takes place in order to restore plasma phosphate, as adequate levels are essential for tissue growth and development. Objective: This study aims to analyze the efficacy of a new parenteral nutrition protocol with updated electrolytic content in reducing the appearance of hydroelectrolytic disorders and its possible impact in associated comorbidities, contributing as a result to audit and improve clinical practice for the optimization of growth and development of very preterm infants. Design: Retrospective cohort study. Setting: Hospital Sant Joan de Déu. Barcelona, Spain