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Hypophosphataemia in infants with CHD treated with amino acid infant formula

Part of: Metabolic

Published online by Cambridge University Press:  15 August 2018

Luise V. Marino Open the ORCID record for Luise V. Marino [Opens in a new window] ,
Prathana Venkatesh ,
Andy Ho ,
R. Mark Beattie  and
Tara Bharucha
Luise V. Marino*
Affiliation:
Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, UK NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, UK Faculty of Health Sciences, University of Southampton, Southampton, UK
Prathana Venkatesh
Affiliation:
Faculty of Medicine, University Hospital Southampton, NHS Foundation Trust, University of Southampton, UK
Andy Ho
Affiliation:
Paediatric Cardiology, University Hospital Southampton NHS Foundation Trust, UK
R. Mark Beattie
Affiliation:
NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, UK Faculty of Medicine, University Hospital Southampton, NHS Foundation Trust, University of Southampton, UK Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, UK
Tara Bharucha
Affiliation:
Faculty of Medicine, University Hospital Southampton, NHS Foundation Trust, University of Southampton, UK Paediatric Cardiology, University Hospital Southampton NHS Foundation Trust, UK
*
Author for correspondence: L. V. Marino, Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton S016 6YD, UK. Tel: +44 (0) 23 8079 6000; Fax: (0) 23 8120 8665; E-mail: [email protected]
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Abstract

Objective

Growth 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.

Methods

The 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 results

In 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).

Conclusion

After 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.

Keywords

CHDamino acid infant formulahypophosphataemiagrowth
Type
Brief Report
Information
Cardiology in the Young , Volume 28 , Issue 11 , November 2018 , pp. 1370 - 1374
Copyright
© Cambridge University Press 2018 

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References

1. van der Linde, D, Konings, EE, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.Google Scholar
2. Medoff-Cooper, B, Ravishankar, C. Nutrition and growth in congenital heart disease: a challenge in children. Curr Opin Cardiol 2013; 28: 122–129.Google Scholar
3. Marino, LV, Magee, A. A cross-sectional audit of the prevalence of stunting in children attending a regional paediatric cardiology service. Cardiol Young 2015: 1–3.Google Scholar
4. Blasquez, A, Clouzeau, H, Fayon, M, et al. Evaluation of nutritional status and support in children with congenital heart disease. Eur J Clin Nutr 2016; 70: 528–531.Google Scholar
5. Luo, WY, Xu, ZM, Hong, L, Wu, QY, Zhang, YY. Nutritional outcomes in infants with food allergy after cardiac surgery. Congenit Heart Dis 2017; 12: 777–782.Google Scholar
6. Muraro, A, Werfel, T, Hoffmann-Sommergruber, K, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69: 1008–1025.Google Scholar
7. Food and Agricultural Organisation of the United States WHO. Standard for infant formula and formulas for speciali medical purpose intended for infants; Codex Stan 72, Codex Alimentarius, International Fodo Standards, 1981. Retrieved February 28, 2018, from http://www.fao.org/fao-who-codexalimentarius/sh-proxy/fr/?lnk=1&url=https%253A%252F%252Fworkspace.fao.org%252Fsites%252Fcodex%252FStandards%252FCODEX%2BSTAN%2B72-1981%252FCXS_072e.pdf.Google Scholar
8. Medoff-Cooper, B, Naim, M, Torowicz, D, Mott, A. Feeding, growth, and nutrition in children with congenitally malformed hearts. Cardiol Young 2010; 20 (Suppl 3): 149–153.Google Scholar
9. Gonzalez Ballesteros, LF, Ma, NS, Gordon, RJ, et al. Unexpected widespread hypophosphatemia and bone disease associated with elemental formula use in infants and children. Bone 2017; 97: 287–292.Google Scholar
10. Berne, Y, Carias, D, Cioccia, AM, Gonzalez, E, Hevia, P. Effect of the diuretic furosemide on urinary essential nutrient loss and on body stores in growing rats. Arch Latinoam Nutr 2005; 55: 154–160.Google Scholar
11. Kliegman, R, Nelson, WE. Nelson Textbook of Pediatrics. Elsevier/Saunders, Philadelphia, PA, 2011.Google Scholar
12. World Health Organization. WHO Anthro (version 3.2.2, January 2011). 2015. WHO, Geneva, Switzerland.Google Scholar
13. World Health Organization. Growth reference 5-19 years: BMI-for-age (5–19years), 2015. Retrieved January 17, 2018, from http://www.who.int/growthref/who2007_bmi_for_age/en/.Google Scholar
14. Blasquez, A, Clouzeau, H, Fayon, M, et al. Evaluation of nutritional status and support in children with congenital heart disease. Eur J Clin Nutr 2016; 70: 528–531.Google Scholar
15. Medoff-Cooper, B, Irving, SY, Hanlon, AL, et al. The association among feeding mode, growth, and developmental outcomes in infants with complex congenital heart disease at 6 and 12 months of age. Jo Pediatr 2016; 169: 154-9.e1.Google Scholar
16. Fukumoto, S. Phosphate metabolism and vitamin D. Bonekey Rep 2014; 3: 497.Google Scholar
17. Bonsante, F, Iacobelli, S, Latorre, G, et al. Initial amino acid intake influences phosphorus and calcium homeostasis in preterm infants – it is time to change the composition of the early parenteral nutrition. PloS one 2013; 8: e72880.Google Scholar
18. Harvey, BM, Langford, JE, Harthoorn, LF, et al. Effects on growth and tolerance and hypoallergenicity of an amino acid-based formula with synbiotics. Pediatr Res 2014; 75: 343–351.Google Scholar
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