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Hypophosphataemia in infants with CHD treated with amino acid infant formula

Hypophosphataemia in infants with CHD treated with amino acid infant formula
Hypophosphataemia in infants with CHD treated with amino acid infant formula

ObjectiveGrowth among infants with CHD is poor, and is multifactorial with multiple contributing factors. Unexplained hypophosphataemia has been reported among infants and children with complex medical needs consuming amino acid infant formula as the sole source of nutrition. The aim of this audit was therefore to review the incidence of hypophosphataemia among infants with CHD.MethodsThe use of an electronic patient record search for "amino acid infant formula", "CHD", and "cardiac" yielded 136 infants <12 months of age. Preterm infants (n=24), children with chromosomal abnormalities (n=4), those >1 year of age (n=11) and infants with a structurally normal heart (n=31) were excluded from the study. The remaining 66 infants with CHD were given amino acid infant formula.Measurements and main resultsIn all, 1059 serum phosphate measures were available. After the introduction of amino acid infant formula, significantly more infants with CHD had episodes of hypophosphataemia: 15% (n=10/66) before treatment versus 29% (n=19/66) after treatment (p=0.049). Mean serum phosphate levels were significantly lower in infants with CHD following consumption of amino acid infant formula (2.0±0.5 versus 1.5±0.5 mmol/L following treatment (p<0.0001)). Infants with CHD and hypophosphataemia, associated with amino acid infant formula, use demonstrated significantly lower weight gain compared with those with normal phosphate levels (weight-for-age z scores -2.1±1.4 versus -0.9±1.5; p<0.0001).ConclusionAfter the introduction of an amino acid formula, weight gain was significantly lower among those infants with low phosphate levels. There was a significantly higher prevalence of hypophosphataemia among infants with CHD after the introduction of amino acid infant formula. Lower phosphate levels were associated with lower weight-for-age z scores. Infants with CHD are susceptible to poor weight gain; it is therefore, crucial the nutritional status of infants prescribed amino acid infant formula is more closely monitored to ensure adequate growth.

amino acid infant formula, CHD, growth, hypophosphataemia
1047-9511
Marino, Luise V.
c479400f-9424-4879-9ca6-d81e6351de26
Venkatesh, Prathana
14c5266d-98e4-4059-a157-31efbfd9decd
Ho, Andy
547619c7-c046-4ab7-b165-2d7082364d5e
Beattie, R. Mark
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Bharucha, Tara
d8f5d152-31e0-49e7-99ac-5fdead9afef8
Marino, Luise V.
c479400f-9424-4879-9ca6-d81e6351de26
Venkatesh, Prathana
14c5266d-98e4-4059-a157-31efbfd9decd
Ho, Andy
547619c7-c046-4ab7-b165-2d7082364d5e
Beattie, R. Mark
9a66af0b-f81c-485c-b01d-519403f0038a
Bharucha, Tara
d8f5d152-31e0-49e7-99ac-5fdead9afef8

Marino, Luise V., Venkatesh, Prathana, Ho, Andy, Beattie, R. Mark and Bharucha, Tara (2018) Hypophosphataemia in infants with CHD treated with amino acid infant formula. Cardiology in the Young. (doi:10.1017/S1047951118001324).

Record type: Article

Abstract

ObjectiveGrowth among infants with CHD is poor, and is multifactorial with multiple contributing factors. Unexplained hypophosphataemia has been reported among infants and children with complex medical needs consuming amino acid infant formula as the sole source of nutrition. The aim of this audit was therefore to review the incidence of hypophosphataemia among infants with CHD.MethodsThe use of an electronic patient record search for "amino acid infant formula", "CHD", and "cardiac" yielded 136 infants <12 months of age. Preterm infants (n=24), children with chromosomal abnormalities (n=4), those >1 year of age (n=11) and infants with a structurally normal heart (n=31) were excluded from the study. The remaining 66 infants with CHD were given amino acid infant formula.Measurements and main resultsIn all, 1059 serum phosphate measures were available. After the introduction of amino acid infant formula, significantly more infants with CHD had episodes of hypophosphataemia: 15% (n=10/66) before treatment versus 29% (n=19/66) after treatment (p=0.049). Mean serum phosphate levels were significantly lower in infants with CHD following consumption of amino acid infant formula (2.0±0.5 versus 1.5±0.5 mmol/L following treatment (p<0.0001)). Infants with CHD and hypophosphataemia, associated with amino acid infant formula, use demonstrated significantly lower weight gain compared with those with normal phosphate levels (weight-for-age z scores -2.1±1.4 versus -0.9±1.5; p<0.0001).ConclusionAfter the introduction of an amino acid formula, weight gain was significantly lower among those infants with low phosphate levels. There was a significantly higher prevalence of hypophosphataemia among infants with CHD after the introduction of amino acid infant formula. Lower phosphate levels were associated with lower weight-for-age z scores. Infants with CHD are susceptible to poor weight gain; it is therefore, crucial the nutritional status of infants prescribed amino acid infant formula is more closely monitored to ensure adequate growth.

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Cardiac Neocate v12 17.6.18 no track changes - Accepted Manuscript
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e-pub ahead of print date: 15 August 2018
Keywords: amino acid infant formula, CHD, growth, hypophosphataemia

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Local EPrints ID: 424203
URI: http://eprints.soton.ac.uk/id/eprint/424203
ISSN: 1047-9511
PURE UUID: 7e67f619-e66e-4a03-b17d-79de4a84a434

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Date deposited: 05 Oct 2018 11:34
Last modified: 07 Oct 2020 06:42

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Contributors

Author: Luise V. Marino
Author: Prathana Venkatesh
Author: Andy Ho
Author: R. Mark Beattie
Author: Tara Bharucha

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