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Response to Letter‐to‐the‐editor

Many thanks to Virella et al. (1) for the observations in their letter to the editor on our recent paper, which found that administering different levels of parenteral phosphate and amino acids did not influence growth in extremely preterm infants (2). We agree that the measurement of growth that we used was not ideal, and we share the scepticism expressed by Virella et al. on the value of clinical routine measures of body length. With that in mind, we took the opportunity to reanalyse our repeated measures of the standard score (Z-score) for body weight using a mixed effects regression model, including small for gestational age and the use of additional phosphate. To increase the strength of the analysis, we compared group two, who were given parenteral nutrition containing a very small amount of phosphate, with the other two groups. This showed that the estimate of effect size was not really changed, with a Z-score of 0.16 and a 95% confidence interval of +0.06 to 0.38 (p = 0.16). We were not able to take twin births into consideration, but this would normally weaken results by reducing the degrees of freedom. So, unfortunately, this analysis confirmed the lack of a significant detrimental effect of low phosphate intake on neonatal weight gain in extremely preterm infants.