5.7 Hyperalimentation and electrolyte requirements in very preterm infants: a randomised controlled parenteral nutrition study

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Abstract

Background

The Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen is a method of hyperalimentation shown to improve early head growth in very preterm infants.1 Early hyperalimentation has been associated with potassium/phosphate deficits.2 The SCAMP regimen uses standardised supplementary electrolyte infusions to immediately correct deficits. We hypothesised that the SCAMP regimen (30% more protein/energy) would require more potassium/phosphate supplementation (Ksupp/Psupp) than a control regimen with the same electrolyte content.

Methods

Control parenteral nutrition (PN) was started within 6 h birth and infants (<1200 g; <29 weeks) were randomised to either start SCAMP or remain on the control regimen. Actual daily nutritional/electrolyte intake and plasma electrolyte data were collected for day1–28.

Results

Infants were randomised (d2–5) to SCAMP (n = 74) and control (n = 76) groups. Maximum differences in protein/energy intakes were achieved day 5–8. These were associated with increased Ksupp/Psupp requirements in SCAMP infants (Table 1). Despite higher mean potassium/phosphate intakes in SCAMP infants (d5–8), mean (sd) plasma levels (mmol/l) were lower (ns): potassium: 4.38 (0.81) versus 4.53 (0.81); phosphate: 1.55 (0.21) versus 1.62 (0.29).

Conclusion

Hyperalimentation using the SCAMP regimen resulted in increased potassium/phosphate requirements. This has implications for standardised PN bag composition.

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