ArticlePloS one2019
Increased risk of refeeding syndrome-like hypophosphatemia with high initial amino acid intake in small-for-gestational-age, extremely-low-birthweight infants.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Incidence and mortality of refeeding syndrome in critically ill patients: a systematic review and meta-analysis.Scientific reports · 2026Pooled it
- Early versus late administration of amino acids in preterm infants receiving parenteral nutrition.The Cochrane database of systematic reviews · 2024Pooled it
- Neonatal refeeding syndrome and postnatal growth in extremely low birth weight infants.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Association between serum phosphate levels and outcome among critically ill newborns: a retrospective cohort study.Frontiers in pediatrics · 2026Article
- The Relationship Between Refeeding Syndrome and Preterm Morbidities in Preterm Infants.Children (Basel, Switzerland) · 2025Article
- Controversies in Parenteral Protein Intake in Preterm Infants.Children (Basel, Switzerland) · 2025Review
- Association between early phosphate intake and refeeding syndrome in extremely low-birth-weight infants: A retrospective cohort study.JPEN. Journal of parenteral and enteral nutrition · 2025Article
- Article
- Effects of high-dose vitamin D supplementation on bone mineral density in very low birth weight preterm infants.Frontiers in endocrinology · 2025Article
- Impact of Refeeding Syndrome on the Short-Term Clinical Outcomes of Very-Premature Infants.Nutrients · 2024Article
- Article
- Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study.BMC pediatrics · 2023Observational
- Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low-Birth-Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial.JPEN. Journal of parenteral and enteral nutrition · 2021Article
- Refeeding Syndrome in the Neonatal Intensive Care Unit.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRecent nutrition guidelines for extremely-low-birth-weight infants (ELBWIs) recommend implementation of high initial amino acid (AA) supplementation in parenteral nutrition.
objectiveWe sought to evaluate the influence of AA intake on refeeding syndrome-like electrolyte disturbances including hypophosphatemia in ELBWIs. STUDY
designMedical records of 142 ELBWIs were reviewed. Demographic, nutritional, outcome, and electrolyte data were compared between ELBWIs with initial low (1.5 g/kg/day) and high (3 g/kg/day) AA intake. Multivariate analysis was conducted to determine the odds ratio of hypophosphatemia with high AA intake and small-for-gestational-age (SGA) ELBWIs.
resultsThe incidence of hypophosphatemia and severe hypophosphatemia increased from 51% and 8% in period I to 59% and 20% in period II, respectively (p = 0.36 and < 0.01). Specifically, SGA ELBWIs showed higher incidence of hypophosphatemia than appropriate-for-gestational age (AGA) ELBWIs in period II, whereas there was no difference in period I. For severe hypophosphatemia, SGA ELBWIs presented a 27% incidence versus a 2% incidence in AGA ELBWIs, even with low initial AA intake. Despite no difference in phosphate intake between infants with and without hypophosphatemia, serum phosphate level reached a nadir at the sixth postnatal day and gradually recovered over the second week in infants with hypophosphatemia. In multivariate analyses, the odds ratios for severe hypophosphatemia were 3.6 and 6.6 with high AA intake and SGA status, respectively, with the highest being 18.0 with combined high AA intake and SGA status.
conclusionsIn summary, high initial AA intake significantly increased the risk of refeeding syndrome-like electrolyte dysregulations including severe hypophosphatemia in ELBWIs. In SGA ELBWIs, the risk of electrolyte disturbance was significantly higher, even with low initial AA intake. Therefore, new tailored parenteral nutrition protocols starting with lower energy intake and a gradual increase over the first week may be warranted for application in high-risk SGA ELBWIs.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.