Clin Nutr ESPEN. 2025 Nov 22:S2405-4577(25)03143-2. doi: 10.1016/j.clnesp.2025.11.150. Online ahead of print.
ABSTRACT
BACKGROUND: Refeeding syndrome (RFS) is a major metabolic complication that may affect preterm infants during the early days of total parenteral nutrition (TPN), particularly when phosphate intake is low.
OBJECTIVE: This study assessed whether early phosphate supplementation initiated on the first day of life reduces the incidence of RFS and improves short-term clinical outcomes in very-preterm infants.
METHODS: A comparative retrospective cohort study (before early phosphate supplementation) and after early phosphate supplementation) was conducted. is study included very-preterm infants who were born at King Saud Medical City, a tertiary referral center, at ≤ 32 weeks of gestation, had a birth weight of <1,500 g, had received TPN immediately after birth, and were admitted to a level III neonatal intensive care unit between January 2015 and December 2025. To adjust for potential confounding factors, the modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber-White) were used.
RESULTS: In total, 962 infants met our inclusion criteria. after the implementation of early phosphate supplementation in TPN, we found a significant reduction in the incidence of RFS (P < 0.001). Further, this group had a lower incidence rate of late-onset sepsis and necrotizing enterocolitis (P = 003, < 0.001, respectively).
CONCLUSIONS: Early phosphate supplementation was associated with a reduced incidence of RFS and improved clinical outcomes in very-preterm infants. Nevertheless, randomized controlled trials should be conducted to validate these findings and inform future nutrition guidelines.
PMID:41285364 | DOI:10.1016/j.clnesp.2025.11.150
