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Acta Paediatr. 2015 Nov;104(11):1077-83. doi: 10.1111/apa.13093. Epub 2015 Aug 4.

Extremely preterm infants who are small for gestational age have a high risk of early hypophosphatemia and hypokalemia.

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Division of Neonatology, Aix-Marseille University, AP-HM, Marseille, France.
Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden.



Electrolyte balances have not been sufficiently evaluated in extremely preterm infants after early parenteral nutrition. We investigated the risk of early hypophosphatemia and hypokalemia in extremely preterm infants born small for gestational age (SGA) who received nutrition as currently recommended.


This prospective, observational cohort study included all consecutive extremely preterm infants born at 24-27 weeks who received high amino acids and lipid perfusion from birth. We evaluated the electrolyte levels of SGA infants and infants born appropriate for gestational age (AGA) during the first five days of life.


The 12 SGA infants had lower plasma potassium levels from Day One compared to the 36 AGA infants and were more likely to have hypokalemia (58% vs 17%, p = 0.001) and hypophosphatemia (40% vs 9%, p < 0.01) during the five-day observation period. After adjusting for perinatal factors, SGA remained significantly associated with hypophosphatemia (odds ratio 1.39, confidence intervals 1.07-1.81, p = 0.01).


Extremely preterm infants born SGA who were managed with currently recommended early parenteral nutrition had a high risk of early hypokalemia and hypophosphatemia. Potassium and phosphorus intakes should be set at sufficient levels from birth onwards, especially in SGA infants.


Extremely low birthweight infants; High protein intake; Hypophosphatemia; Refeeding syndrome; Small for gestational age

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