{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:19:07Z","timestamp":1793395147261,"version":"4.5.0"},"reference-count":15,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2017,3,9]]},"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To compare in two epochs of differing phosphate provision serum calcium, phosphate, potassium, and sodium concentrations and the frequency of abnormality of these electrolytes and of sepsis in preterm infants who received an optimised higher amino acid-content formulation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and setting<\/jats:title>\n                  <jats:p>Retrospective cohort study at a single tertiary-level neonatal unit.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Preterm infants given parenteral nutrition (PN) in the first postnatal week during two discrete 6-month epochs in 2013\u20132014.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>In epoch 1 the Ca<jats:sup>2+<\/jats:sup>:PO<jats:sub>4<\/jats:sub> molar ratio of the PN formulation was ~1.3\u20131.5:1 (1.7\u2009mmol Ca<jats:sup>2+<\/jats:sup> and 1.1\u2009mmol PO<jats:sub>4<\/jats:sub> per 100\u2009mL aqueous phase) and in epoch 2 was 1.0:1 via extra phosphate supplementation (1.7\u2009mmol Ca<jats:sup>2+<\/jats:sup> and 1.7\u2009mmol PO<jats:sub>4<\/jats:sub> per 100\u2009mL).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Peak calcium and nadir phosphate and potassium concentrations, and proportions with severe hypercalcaemia (Ca<jats:sup>2+<\/jats:sup> &gt;3.0\u2009mmol\/L), hypophosphataemia (PO<jats:sub>4<\/jats:sub>&lt;1.5\u2009mmol\/L), and hypokalaemia (K<jats:sup>+<\/jats:sup> &lt;3.5\u2009mmol\/L) within the first postnatal week.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In epoch 2, peak calcium concentrations were lower than in epoch 1 (geometric means: 2.83 mmol\/L vs 3.09\u2009mmol\/L, p value&lt;0.0001), fewer babies were severely hypercalcaemic (10\/49, 20%, vs 31\/51, 61%, p value&lt;0.0001); nadir plasma phosphate concentrations were higher (means: 1.54 mmol\/L vs 1.32 mmol\/L, p value=0.006), and there were fewer cases of hypophosphataemia (17\/49, 35% vs 31\/51, 61%, p value=0.009) and hypokalaemia (12\/49, 25% vs 23\/51, 45%, p value=0.03).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Reverting from a PN Ca<jats:sup>2+<\/jats:sup>:PO<jats:sub>4<\/jats:sub> molar ratio of 1.3\u20131.5:1 to a ratio of 1.0:1 was associated with a lower incidence and severity of hypophosphataemia and hypercalcaemia. For preterm infants given higher concentrations of amino acids (\u22652.5\u2009g\/kg\/day) from postnatal day 1, an equimolar Ca<jats:sup>2+<\/jats:sup>:PO<jats:sub>4<\/jats:sub> ratio may be preferable during the first postnatal week.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2016-311107","type":"journal-article","created":{"date-parts":[[2017,4,29]],"date-time":"2017-04-29T20:20:15Z","timestamp":1493497215000},"page":"F451-F455","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Severe hypercalcaemia and hypophosphataemia with an optimised preterm parenteral nutrition formulation in two epochs of differing phosphate supplementation"],"prefix":"10.1136","volume":"102","author":[{"given":"Shaveta","family":"Mulla","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, Jenny Lind Children\u2019s Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Stirling","sequence":"additional","affiliation":[{"name":"Norwich Clinical Trials Unit, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Cowey","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Jenny Lind Children\u2019s Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Close","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Jenny Lind Children\u2019s Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pullan","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Jenny Lind Children\u2019s Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind","family":"Howe","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Jenny Lind Children\u2019s Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne","family":"Radbone","sequence":"additional","affiliation":[{"name":"East of England Neonatal Operational Delivery Network, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6203-7632","authenticated-orcid":false,"given":"Paul","family":"Clarke","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Jenny Lind Children\u2019s Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,4,29]]},"reference":[{"key":"2025090510123640000_102.5.F451.1","first-page":"S1","article-title":"1. 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Fetal and Neonatal Edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2016-311107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T17:17:57Z","timestamp":1757092677000},"score":1,"resource":{"primary":{"URL":"https:\/\/fn.bmj.com\/lookup\/doi\/10.1136\/archdischild-2016-311107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,29]]},"references-count":15,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2017,8,18]]},"published-print":{"date-parts":[[2017,9]]}},"alternative-id":["10.1136\/archdischild-2016-311107"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2016-311107","relation":{},"ISSN":["1359-2998","1468-2052"],"issn-type":[{"value":"1359-2998","type":"print"},{"value":"1468-2052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,29]]}}}