P1022 - IMPACT OF INCREASED PHOSPHATE IN TOTAL PARENTERAL NUTRITION ON THE INCIDENCE OF REFEEDING SYNDROME IN PRETERM INFANTS: A COMPARATIVE STUDY

P1022

IMPACT OF INCREASED PHOSPHATE IN TOTAL PARENTERAL NUTRITION ON THE INCIDENCE OF REFEEDING SYNDROME IN PRETERM INFANTS: A COMPARATIVE STUDY

S. Assfour^1,*, M. M. Almouqdad²

¹Clinical Pharmacy Department, ²NICU, King Saud Medical City, Riyadh, Saudi Arabia

Rationale: The aim of this study is to evaluate the effect of increasing phosphate content in TPN on the incidence of refeeding syndrome in preterm infants.

Methods: A comparative study with retrospective (before phosphate increase in starter TPN; January 2016 and December 2022) and prospective (after phosphate increase in starter TPN; January 2023 and December 2024) cohorts. This study included preterm infants who were born at King Saud Medical City, a tertiary referral center, at ≤32 weeks of gestation, had a birth weight of <1500 g, received PN immediately after birth and admitted to a level 3 neonatal intensive care unit (NICU). Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber–White) were used to adjust for potential confounding factors.

Results: A total of 962 infants met our inclusion criteria. A significant reduction in the incidence of refeeding syndrome was observed in the prospective group after increasing phosphate in TPN (P<0.001). Infants with prospective group had lower late onset of sepsis and necrotizing enterocolitis (P=003, <0.001; respectively).  After excluding mortality cases; the average TPN duration and length of hospital stay was significantly reduced after increasing phosphate supplementation (P<0.001, <0.001; respectively). In addition, increasing phosphate in TPN led to significant improve in z score at time of discharge (P=0.03).

Image:

Conclusion: Optimizing phosphate in PN significantly reduces the incidence of refeeding syndrome in preterm infants. Given these interesting results, we strongly recommend an early initiation of phosphate as a standard component of neonatal starter PN protocols to enhance the care and survival of preterm infants.

Disclosure of Interest: None declared