Incidence of Refeeding Syndrome in Children With Failure to Thrive

Abstract

OBJECTIVES: To determine the incidence of refeeding syndrome in otherwise healthy children <3 years of age admitted for failure to thrive (FTT). METHODS: A multicenter retrospective cohort study was performed on patients aged ≤36 months admitted with a primary diagnosis of FTT from January 1, 2011, to December 31, 2016. The primary outcome measure was the percentage of patients with laboratory evidence of refeeding syndrome. Exclusion criteria included admission to an ICU, parenteral nutrition, history of prematurity, gastrostomy tube feeds, and any complex chronic conditions. RESULTS: Of the 179 patients meeting inclusion criteria, none had laboratory evidence of refeeding syndrome. Of these, 145 (81%) had laboratory work done at the time of admission, and 69 (39%) had laboratory work repeated after admission. A small percentage (6%) of included patients experienced an adverse event due to repeat laboratory draw. CONCLUSIONS: In otherwise healthy hospitalized patients <3 years of age with a primary diagnosis of FTT, routine laboratory monitoring for electrolyte derangements did not reveal any cases of refeeding syndrome. More robust studies are needed to determine the safety and feasibility of applying low-risk guidelines to this patient population to reduce practice variability and eliminate unnecessary laboratory evaluation and monitoring.

Incidence of Refeeding Syndrome in Critically Ill Children With Nutritional Support

“…Recently, a systematic review by Bradford et al ( 28 ) concluded that the incidence of RS in neonatology based on electrolyte disorders of P, K, and Mg is unknown, with most studies assessing hypophosphatemia only. Other studies have reported incidences of 0% ( 29 ), 14% ( 30 ), 15% ( 8 ), 19% ( 31 ), 23% ( 32 ), and 60% ( 33 ), respectively, but none of these studies were conducted in PICUs. The results highlight the complexity of identifying RS in critically ill children for several reasons.…”