Affiliation:
1. Neonatal Intensive Care Unit Royal North Shore Hospital St Leonards New South Wales Australia
2. University of Sydney Sydney New South Wales Australia
Abstract
AimLate‐onset sepsis (LOS) is common in extreme prematurity. These infants are at risk of refeeding syndrome‐associated hypophosphataemia. Our objective was to investigate whether hypophosphataemia predisposes to LOS in extremely premature neonates.MethodsA retrospective case–control study of neonates born before 29 weeks' gestation in an Australian NICU from 2016 to 2020. Cases developed LOS or localised infection. Two controls, matched within 2 gestational weeks and 90 calendar days, were selected per case.ResultsAmongst 48 cases and 93 controls, cases were smaller at birth (767 g vs. 901 g, P = 0.01), but were otherwise comparable. Hypophosphataemia was more common in cases (26% vs. 15%, P = 0.18). Increased intravenous protein intake in the first week was protective against LOS (OR = 0.9, 95% CI 0.76–1.00, P = 0.04); median 2.1 g/kg/day in cases, 2.3 g/kg/day in controls.ConclusionsHypophosphataemia as part of refeeding syndrome is prevalent and under‐recognised in extremely premature neonates. We did not find an association between hypophosphataemia and LOS. Low intravenous protein may be an independent risk factor for infection.