236 - Risk Factors for the Development of Hyperkalemia with Feed Fortification in the Neonatal Intensive Care Unit

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 236
Publication Number: 236.243

Natalie Pudalov, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Katherine Twombley, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Anita T. Perez, Medical University of South Carolina College of Medicine, Charleston, SC, United States

Presenting Author(s)

Natalie Pudalov, MD

Resident Physician
Medical University of South Carolina College of Medicine
Charleston, South Carolina, United States

Background:

Premature infants have increased nutritional needs compared to term babies and often require the use of human milk fortifier (HMF) to promote growth. Our center has noticed a recent increase in hyperkalemia (HyperK) after some of our preterm infants undergo fortification. This pilot study was designed to explore the risk factors for the development of HyperK with formula fortification.

Objective:

This was a retrospective chart review of 11 preterm infants admitted to our level IV NICU that were consulted on by pediatric nephrology for HyperK, defined as a potassium (K+) greater than 6mEq/L on any non-hemolyzed blood sample. Patient demographics, prenatal risk factors, as well as clinical and laboratory data were analyzed and are included in Table 1. Infants with congenital heart disease, excluding patent ductus arteriosus (PDA), and renal anomalies were excluded from the study. Respiratory support was defined as mild (nasal cannula), moderate (NIPPV or CPAP), or severe (conventional, oscillator, or high frequency ventilation).

Design/Methods:

All of the patients had a PDA at the time of fortification and all of the patients were on moderate to severe respiratory support. Renal function immediately prior to fortification was compared to each patient’s nadir creatinine and 100% of patients were at or above their nadir creatinine (72.7% were above and 27.3% at nadir). No patients were on pressor support or had any known infections.

Results: In our small pilot study, we noted that a large percentage of the infants that developed hyperkalemia with HMF fortification were < 27 weeks GA, < 800 grams at birth, had a PDA and were on moderate to severe respiratory support.

Conclusion(s): This data will be used to design a prospective study to compare infants that do and do not develop hyperK with HMF fortification. Insight into the risk factors of hyperkalemia and HMF will aid neonatologists, nephrologists and dieticians in deciding timing and candidacy for feed fortification in premature infants.