Sodium glycerophosphate and prescribed calcium concentrations in pediatric parenteral nutrition: a retrospective observational study and economic evaluation

Characteristics	Number of orders (%)
Sex
Male	1,154 (52.6)
Female	1,038 (47.4)
Age
Newborn to 12 months	1,859 (84.8)
>12 months	333 (15.2)
Primary medical conditions
Short bowel syndrome	220 (10.0)
Preterm or very low-birth-weight infant	837 (38.2)
Others*	1,096 (50.0)
Not specified	39 (1.8)
Nutritional assessment according to pediatricians
Normal	6 (0.3)
Mild malnutrition	1,212 (55.3)
Moderate malnutrition	518 (23.6)
Severe malnutrition	209 (9.5)
Not specified	247 (11.3)

[i] *Necrotizing enterocolitis, encephalitis, gastroschisis, omphalocele, inflammatory bowel disease, sepsis, chylothorax, gut perforation, gut obstruction, and congenital heart defect, etc.

Table 2

Minerals and amino acid concentrations prescribed in all pediatrie parenteral nutrition orders

Phosphate product	Orders (n)	Orders that required reduced calcium concentration (%)	Data shown as median (25th percentile-75th percentile) [minimum, maximum]
			Calcium (mmol/L)	Phosphorus (mmol/L)	Sodium (mmol/L)	Potassium (mmol/L)	Magnesium (mmol/L)	Trace element (mL/L)	Amino acid (%)
Central line	1,347
NaGlyP	1,289	1 (0.1)	12.98	11.00	37.22	28.97	2.55	12.50	3.03
			(5.82-25.04)	(4.80-18.68)	(25.83-58.00)	(19.05-40.80)	(1.84-4.05)	(9.17-16.67)	(2.31-4.40)
			[0.84,139.91]	[1.65,83.64]	[3.48,426.67]	[0.00, 250.00]	[0.00,40.50]	[0.00,100.00]	[0.00,11.25]
Dipotassium	52	23 (44.2)	2.90	11.58	11.75	34.62	3.16	16.59	3.50
phosphate			(1.68-5.86)	(6.91-16.53)	(5.31-22.68)	(20.26-66.02)	(1.92-3.63)	(13.08-22.27)	(2.5-4.21)
			[0.00,12.21]	[2.63, 56.04]	[0.00,114.87]	[7.75,188.46]	[0.00,12.89]	[7.93, 37.50]	[0.95,6.00]
Mixed both	6	3(50)	2.23	22.86	31.33	27.49	2.09	9.47	2.00
phosphate salts			(1.99-6.83)	(15.20-23.21)	(19.46-41.00)	(19.46-37.08)	(1.77-3.75)	(7.14-13.22)	(1.79-2.06)
			[1.82,26.57]	[11.38,23.92]	[8.62,57.14]	[5.17,60.95]	[1.35,10.03]	[0.00, 33.33]	[1.67,2.83]
**^P***			<0.001	0.11	<0.001	0.08	0.83	<0.001	0.02
Peripheral line	845
NaGlyP	839	0(0.)	27.00	17.27	37.26	25.55	2.36	11.58	2.80
			(20.28-35.76)	(12.42-22.67)	(28.48-48.47)	(19.07-33.33)	(1.80-3.13)	(9.17-15.20)	(2.13-3.53)
			[1.69,119.86]	[1.50,96.36]	[3.65,192.73]	[0.00,357.14]	[0.00,90.00]	[0.00,115.00]	[0.65, 27.5]
Dipotassium	3	2(67)	1.95	8.22	27.43	32.89	1.66	16.47	3.29
phosphate			(1.95-2.64)	(7.28-8.22)	(24.30-31.44)	(29.14-32.89)	(1.48-1.66)	(14.60-16.47)	(2.92-3.29)
			[1.95,3.33]	[6.35,8.22]	[21.17,35.44]	[25.39, 32.89]	[1.30,1.67]	[12.73,16.47]	[2.55, 3.29]
Mixed both	3	0(0)	6.44	12.94	24.29	25.88	2.62	12.92	3.23
phosphate salts			(5.94-7.66)	(11.93-15.35)	(18.64-33.68)	(23.56-30.70)	(2.42-3.12)	(11.90-15.32)	(2.70-3.83)
			[5.44,8.88]	[10.92,17.76]	[22.67, 38.46]	[21.83,35.53]	[2.23, 3.62]	[10.88,17.71]	[2.17,4.43]
**^p***			<0.001	0.03	0.11	0.12	0.02	0.06	0.66

[i] ^*An independent-samples Kruskal-Wallis test was used to determine differences between the 3 groups

NaGlyP, sodium glycerophosphate

Table 3

Mineral and amino acid concentrations prescribed in preterm infants

Phosphate products (No. orders)	Data shown as median (25th percentile–75th percentile) [minimum, maximum]
	Calcium (mmol/L)	Phosphorus (mmol/L)	Sodium (mmol/L)	Potassium (mmol/L)	Magnesium (mmol/L)	Trace element (mL/L)	Amino acid (%)
NaGlyP
Central line	29.36	17.00	35.56	25.45	2.58	12.50	2.72
(227)	(22.27–37.99)	(12.07–23.50)	(26.67–50.91)	(18.18–33.33)	(1.84–3.24)	(9.11–15.58)	(2.00–3.83)
	[2.37, 83.25]	[1.74, 50.00]	[3.48, 118.81]	[0.00, 112.06]	[0.00, 9.64]	[6.25, 37.50]	[0.63, 11.25]
Peripheral line	30.00	18.93	38.75	26.20	2.48	12.29	3.00
(362)	(24.19–39.63)	(14.01–25.00)	(29.20–48.47)	(20.00–34.00)	(1.97–3.32)	(9.85–16.52)	(2.33–3.69)
	[3.60, 75.09]	[2.82, 50.00]	[11.82, 100.00]	[0.00, 65.00]	[0.00, 40.5]	[6.36, 115.00]	[0.70, 8.25]

[i] NaGlyP, sodium glycerophosphate

Table 4

Costs of phosphate products used per bag

Phosphate products	Costs (USD)/bag median (25th percentile–75th percentile) [minimum, maximum]	Costs (THB)/bag median (25th percentile–75th percentile) [minimum, maximum]
NaGlyP	1.04	35.88
	(0.77–1.45)	(26.22–49.68)
	[0.16, 32.77]	[5.52, 1,121.94]
Dipotassium	1.20	41.25
phosphate	(0.56–1.57)	(19.35–53.66)
	[0.26, 14.34]	[9.13, 490.93]
Mixed both	2.03	69.63
phosphate salts	(1.58–2.11)	(53.97–72.22)
	[0.59, 5.48]	[20.25, 187.96]
P*	0.03	0.03

[i] *An independent-samples Kruskal–Wallis test was used to determine differences between the 3 groups

NaGlyP, sodium glycerophosphate; THB, Thai baht

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DOI: https://doi.org/10.1515/abm-2019-0024 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415

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Language: English

Page range: 229 - 235

Published on: Oct 1, 2019

Published by: Chulalongkorn University

In partnership with: Paradigm Publishing Services

Keywords:

alpha-glycerophosphoric acid,

glycerophosphates,

calcium,

chemical precipitation,

parenteral nutrition,

phosphates

Related subjects:

Medicine,

Assistive professions, nursing,

Basic medical science,

Basic medical science, other,

Clinical medicine,

Clinical medicine, other

© 2019 Tippawan Siritientong, Suree Nimitwongsin, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 12 (2018): Issue 5 (October 2018)