Annals of Clinical Nutrition and Metabolism

Original Articles

Association between the calcium-to-phosphorus ratio and early hypophosphatemia in preterm infants receiving parenteral nutrition in Korea: a retrospective cohort study: Miseon Han, Jin Ok Kyun, Yoong-A Suh, Jang Hoon Lee; Ann Clin Nutr Metab 2026;18(1):44-53. Published online March 30, 2026; DOI: https://doi.org/10.15747/ACNM.25.0039

Graphical Abstract Abstract PDF Supplementary Material: Purpose
This study aimed to evaluate the association between the calcium-to-phosphorus (Ca/P) ratio and serum phosphate levels in preterm infants receiving total parenteral nutrition (TPN) and to explore Ca/P ratio ranges associated with hypophosphatemia.
Methods
We retrospectively reviewed the medical records of preterm infants admitted to the neonatal intensive care unit at Ajou University Hospital between January 2022 and June 2024. The review focused on TPN composition and serum electrolyte changes during the first week of life. Based on the cumulative Ca/P ratio during this period, infants were categorized into two groups: Ca/P-Low (mass ratio ≤1.3) and Ca/P-High (mass ratio >1.3).
Results
A total of 117 preterm infants were included in the analysis (Ca/P-Low group, n=46; Ca/P-High group, n=71). During the first week of life, the cumulative phosphorus deficit was significantly greater in the Ca/P-High group (61.4 mg/kg vs. 8.5 mg/kg; P<0.001). By day of life (DOL) 7, both hypophosphatemia and severe hypophosphatemia had increased markedly in the Ca/P-High group compared with DOL 3. In the Ca/P-High group, the incidence of hypophosphatemia increased from 44.4% on DOL 3 to 75.0% on DOL 7, while the incidence of severe hypophosphatemia increased from 4.8% to 23.1%.
Conclusion
These findings suggest that parenteral nutrition strategies may benefit from phase-adapted Ca/P ratios rather than a fixed ratio during the first week of life. A higher ratio may be considered during DOL 0–2, whereas a lower ratio may be considered during DOL 3–6, particularly when overall calcium and phosphorus supply is suboptimal.

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Effect of Nutritional Intervention by the Nutrition Support Team on Postnatal Growth in Preterm Infants: So Jin Yoon, Joo Hee Lim, Soon Min Lee, Sun Jung Kim, Sun Kyung Lee, Soo Min Lee; J Clin Nutr 2020;12(2):26-33. Published online December 31, 2020; DOI: https://doi.org/10.15747/jcn.2020.12.2.26

Purpose: Nutritional intervention by an interdisciplinary nutrition support team (NST) can potentially improve postnatal growth outcomes in preterm infants. This study aimed to measure the growth impact of a nutritional intervention package performed by an NST in a quality improvement effort in a neonatal intensive care unit (NICU).
Methods: Fifty-two infants born below 2,000 g and admitted to NICU participated in the Quality Improvement (QI) program between March 2016 and February 2017. The nutritional intervention was applied according to newly established nutritional guidelines on parenteral and enteral nutrition, and an NST performed a weekly nutritional assessment. The Z-scores of weight, height, and head circumference were calculated according to the gestational age and sex. The clinical impact on postnatal growth was compared between the QI and pre-QI groups. The pre-QI group included 69 infants admitted in the same NICU between 2014 and 2015.
Results: The time to the initiation of enteral nutrition decreased significantly (P<0.001). Changes in weight (P=0.027), head circumference (P=0.003), Z-scores between birth, and 40 weeks postconceptional age (PCA) were significantly larger in the QI than the pre-QI group. The percentage of infants weighing below the 10th percentile at one month after birth and at 40 weeks PCA was higher in the pre-QI than the QI group.
Conclusion: The implementation of evidence-based best practices for preterm nutrition resulted in significant improvements in the growth outcomes in preterm infants.

Citations

Citations to this article as recorded by

Nutrition Supply and Growth Post Nutrition Support Team Activity in Neonatal Intensive Care Unit
Hye Min Ha, Yu Jin Jung, Yoo Rha Hong, So Yoon Choi
Pediatric Gastroenterology, Hepatology & Nutrition.2024; 27(5): 313. CrossRef

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