Early hypophosphataemia and refeeding syndrome in extremely low birthweight babies and outcomes to 2 years of age: secondary cohort analysis from the ProVIDe trial.
Nadia Ford, Frank Harry Bloomfield, Yannan Jiang, Barbara Elizabeth Cormack
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引用次数: 0
Abstract
Objective: To investigate in extremely low birthweight (ELBW; <1000 g) babies the associations between refeeding syndrome (serum phosphate <1.4 mmol·L-1 and serum total calcium>2.8 mmol·L-1) and hypophosphataemia in the first week and death or neurodisability at 2 years' corrected age (CA).
Design: Secondary cohort analysis of the ProVIDe trial participants with serum biochemistry within 7 days of birth. At 2 years' CA, neurodisability was assessed by Bayley Scales of Infant Development Edition III and neurological examination. Associations between neurodisability and other variables were analysed using t-tests and logistic regression adjusted for sex and smallness-for-gestational age.
Setting: Six tertiary neonatal intensive care units (NICUs) in New Zealand.
Participants: 352 ELBW babies born between 29 April 2014 and 30 October 2018.
Main outcome measure: Death or neurodisability at 2 years' CA.
Results: Fifty-nine babies died, two after discharge from the NICU. Of the 336 babies who survived to 2 years' CA, 277 had neurodevelopmental assessment and 107 (39%) had a neurodisability. Death or neurodisability was more likely in babies who had refeeding syndrome (aOR 1.96 (95% CI 1.09 to 3.53), p=0.02) and in babies who had hypophosphataemia (aOR 1.74 (95% CI 1.09 to 2.79), p=0.02). Hypophosphataemia was associated with increased risk of death (aOR 2.07 (95% CI 1.09 to 3.95), p=0.03)) and severe hypophosphataemia (<0.9 mmol·L-1) with increased risk of death (aOR 2.67 (95% CI 1.41 to 5.00), p=0.002) and neurodisability (aOR 2.31 (95% CI 1.22 to 4.35), p=0.01).
Conclusions: In ELBW babies, refeeding syndrome and hypophosphataemia in the first week are associated with death or neurodisability. Until optimal phosphate requirements are determined through further research, monitoring for hypophosphataemia and mitigation strategies are indicated.
目的调查极低出生体重儿（ELBW；-1和血清总钙>2.8 mmol-L-1）和第一周低磷血症与2岁矫正年龄（CA）时死亡或神经残疾的关系：设计：对出生后7天内进行血清生化检查的ProVIDe试验参与者进行二次队列分析。2岁时，通过Bayley婴儿发育量表第三版和神经系统检查评估神经残疾情况。采用t检验和逻辑回归分析神经残疾与其他变量之间的关系，并根据性别和胎龄调整：环境：新西兰六家三级新生儿重症监护病房（NICU）：2014年4月29日至2018年10月30日期间出生的352名ELBW婴儿：2岁CA时死亡或神经残疾：59名婴儿死亡，其中2名在从新生儿重症监护室出院后死亡。在存活2年的336名婴儿中，277名接受了神经发育评估，107名（39%）出现神经残疾。患有反哺综合征（aOR 1.96 (95% CI 1.09 to 3.53)，p=0.02）和低磷血症（aOR 1.74 (95% CI 1.09 to 2.79)，p=0.02）的婴儿更容易死亡或出现神经残疾。低磷血症与死亡风险增加（aOR为2.07（95% CI为1.09至3.95），p=0.03）相关，严重低磷血症（-1）与死亡风险增加（aOR为2.67（95% CI为1.41至5.00），p=0.002）和神经残疾（aOR为2.31（95% CI为1.22至4.35），p=0.01）相关：在 ELBW 婴儿中，第一周的再喂养综合症和低磷血症与死亡或神经残疾有关。在通过进一步研究确定最佳磷酸盐需求量之前，应监测低磷血症并采取缓解策略：ACTRN12612001084875。
期刊介绍：
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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