Towards Optimizing Calcium and Phosphate Concentration in Parenteral Nutrition for Premature Neonates to Minimize Rickets of Prematurity

Excerpt

To the Editor: It has been shown that organic calcium and organic phosphorus have high solubility in parenteral nutrition [1]. Therefore such preparations make it possible to achieve daily intake of calcium and phosphorus recommended for premature neonates by European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/European Society for Clinical Nutrition and Metabolism (ESPEN) (3 mmol/kg/d and 2.3 mmol/kg/d respectively) [2]. ESPGHAN/ESPEN guideline is based on fetal accretion rate and meeting the recommendation might ameliorate rickets of prematurity. However, much lower calcium and phosphorus concentrations are still commonly in use as reflected by the guidelines of parenteral nutrition for preterm babies in two western countries [3, 4]. The concentrations of calcium and phosphorus are 1.2 mmol/100 ml and 1 mmol/100 ml respectively [4]. In face with these guidelines the pharmacists in Hong Kong were reluctant to accept prescription of high concentration of calcium and phosphorus in parenteral nutrition aimed at achieving ESPGHAN/ESPEN recommendation; even organic calcium (10% calcium gluconate) and organic phosphorus (sodium glycophos) were used until we performed a compatibility study described as follows. …