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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.
Trial registration number ACTRN12612001084875
- Biochemistry
- Child Development
- Intensive Care Units, Neonatal
- Mortality
- Micronutrients
Data availability statement
Data are available upon reasonable request. Data are available on reasonable request to the Liggins Institute Data Access Committee.
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Data availability statement
Data are available upon reasonable request. Data are available on reasonable request to the Liggins Institute Data Access Committee.
Footnotes
Collaborators The ProVIDe Trial Group New Zealand Sites: Liggins Institute, University of Auckland: Frank Bloomfield, Yannan Jiang, Jane Harding, Caroline Crowther, Barbara Cormack; Dunedin Hospital, Dunedin: Roland Broadbent and Frances McCaffrey; Christchurch Women’s Hospital, Christchurch: Adrienne Lynn, Carole Spencer, Nicola Ellis and Trish Graham; Wellington Regional Hospital, Wellington: Michael Hewson, Harshad Patel, Mel Gibson and Natalie Wilkes; Waikato Hospital, Hamilton: Arun Nair, Deborah Harris, Nicola Streifler, Stephanie Edwards, Rebecca Sisterson and Kimberly Akehurst; Middlemore Hospital, Auckland: Mike Meyer, Aiza de Monteverde, Audrey Yu, Cristina Tapnio and Tanith Alexander; Auckland City Hospital, Auckland: Barbara Cormack and Sabine Huth; Australian Sites Mater Health Services, Brisbane: Helen Liley and Suzanne Bates; The Royal Women’s Hospital, Melbourne: Sue Jacobs, Brenda Argus and Emily Twitchell.
Contributors BEC, NF and FHB developed the study conception, and BEC, YJ and FHB directed the study’s analytical strategy. NF conducted the data analysis and wrote initial draft of the manuscript. All the authors contributed to the interpretation of the data, critically revising the paper and approval of the manuscript as submitted. BEC is the guarantor.
Funding New Zealand Health Research Council (http://www.hrc.govt.nz; 14/174), Lotteries Grants Board (http://www.communitymatters.govt.nz; 3705291), Cure Kids (www.curekids.org.nz; 3550 and 3580), A+ Trust and the Nurture Foundation (www.adhb.govt.nz; A+5854); and Gravida: National Centre for Growth and Development (SCH 14/15). The funders had no influence on the design or conduct of the trial and were not involved in data collection or analysis, in the writing of the manuscript or in the decision to submit it for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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