Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
Address for correspondence: Dr. Sreekanth Viswanathan, Case Western Reserve University, Rainbow Babies and Children’s Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106-6010, USA. Tel.: +1 216 844 3387; Fax: +1 216 844 3380;
Abstract: BACKGROUND: In response to a national shortage of parenteral phosphorus solutions (2013), a hospital-wide phosphorus dose restriction strategies was implemented which included judicious use of phosphorus in preterm infants <1250 g birth weight and no parenteral phosphorus in preterm infants >1250 g birth weight unless they have a critically low phosphorus level. OBJECTIVE: To study the effect of parenteral phosphorus dose restriction in preterm infants admitted to the neonatal intensive care unit. METHODS: Preterm infants (≤35 weeks birth gestation and ≤2500 g birth weight) who received parenteral nutrition, survived >1 week and had no major congenital anomalies were studied. Clinical and laboratory data in the first 4 weeks of life of infants admitted during the parenteral phosphorus shortage (cases) were compared to infants who were admitted 6 months prior to the shortage (controls). RESULTS: Twenty consecutive cases were compared to 40 consecutive controls. Cases had lower serum phosphorus levels, higher serum alkaline phosphatase levels, and need for greater inotropic support compared to controls. These differences were significant only in preterm infants with birth weight >1250 g, the group who received more parenteral phosphorus dose restriction while they were similar in preterm infants with birth weight <1250 g. CONCLUSION: The modest effects of phosphorus dose restriction may become more clinically important if shortage is prolonged or severe or if it involves extreme preterm infants.
Keywords: Phosphorous, preterm, metabolic bone disease, parenteral shortage