Risk Factors for the Development of Refeeding Syndrome-Like Hypophosphatemia in Very Low Birth Weight Infants

Igarashi, Aiko; Okuno, Takashi; Ohta, Genrei; Tokuriki, Shuko; Ohshima, Yusei

doi:10.1155/2017/9748031

Cited by 16 publications

(29 citation statements)

References 21 publications

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“…Urinary excretion of phosphorus and potassium was lower in these patients, suggesting that low levels were not caused by urinary loss 55 . In a subsequent observation, higher rates of electrolyte abnormalities were found, including hypophosphatemia, in patients with IUGR and VLBW 57 . Others have reported hypophosphatemia and hypokalemia in neonates receiving PN.…”

Section: Incidence Of Refeeding Syndromementioning

confidence: 75%

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ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

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Introduction In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. Methods Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. Findings/Recommendations This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%–20% (mild), 20%–30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. Conclusions These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.

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Section: Incidence Of Refeeding Syndromementioning

confidence: 75%

“…55 In a subsequent observation, higher rates of electrolyte abnormalities were found, including hy-pophosphatemia, in patients with IUGR and VLBW. 57 Others have reported hypophosphatemia and hypokalemia in neonates receiving PN. These authors have stressed the importance of close monitoring and electrolyte repletion.…”

Section: Incidence Of Refeeding Syndromementioning

confidence: 99%

ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

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“…Several studies have reported that early aggressive PN with high initial AA intake in micropreemies increased the risk of early refeeding syndrome–like electrolyte disturbances such as hypophosphatemia and hypokalemia [15–18]. Additionally, small for gestational age (SGA) micropreemies suffering from intrauterine growth restriction due to chronic undernourishment during the fetal period have been reported to develop refeeding syndrome–like severe hypophosphatemia and hypokalemia following initiation of PN soon after birth [10,11,15,16]. Beginning in October 2013, we changed the PN protocol from low (1.5 g/kg/day) to high (3 g/kg/day) initial AA intake in ELBWIs.…”

Section: Introductionmentioning

confidence: 99%

Increased risk of refeeding syndrome–like hypophosphatemia with high initial amino acid intake in small-for-gestational-age, extremely-low-birthweight infants

et al. 2019

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Background Recent nutrition guidelines for extremely-low-birth-weight infants (ELBWIs) recommend implementation of high initial amino acid (AA) supplementation in parenteral nutrition. Objective We sought to evaluate the influence of AA intake on refeeding syndrome–like electrolyte disturbances including hypophosphatemia in ELBWIs. Study design Medical records of 142 ELBWIs were reviewed. Demographic, nutritional, outcome, and electrolyte data were compared between ELBWIs with initial low (1.5 g/kg/day) and high (3 g/kg/day) AA intake. Multivariate analysis was conducted to determine the odds ratio of hypophosphatemia with high AA intake and small-for-gestational-age (SGA) ELBWIs. Results The incidence of hypophosphatemia and severe hypophosphatemia increased from 51% and 8% in period I to 59% and 20% in period II, respectively (p = 0.36 and < 0.01). Specifically, SGA ELBWIs showed higher incidence of hypophosphatemia than appropriate-for-gestational age (AGA) ELBWIs in period II, whereas there was no difference in period I. For severe hypophosphatemia, SGA ELBWIs presented a 27% incidence versus a 2% incidence in AGA ELBWIs, even with low initial AA intake. Despite no difference in phosphate intake between infants with and without hypophosphatemia, serum phosphate level reached a nadir at the sixth postnatal day and gradually recovered over the second week in infants with hypophosphatemia. In multivariate analyses, the odds ratios for severe hypophosphatemia were 3.6 and 6.6 with high AA intake and SGA status, respectively, with the highest being 18.0 with combined high AA intake and SGA status. Conclusions In summary, high initial AA intake significantly increased the risk of refeeding syndrome–like electrolyte dysregulations including severe hypophosphatemia in ELBWIs. In SGA ELBWIs, the risk of electrolyte disturbance was significantly higher, even with low initial AA intake. Therefore, new tailored parenteral nutrition protocols starting with lower energy intake and a gradual increase over the first week may be warranted for application in high-risk SGA ELBWIs.

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Section: Introductionmentioning

confidence: 99%

“…Early hypophosphatemia after birth has emerged as a common problem in extremely preterm patients or premature infants with intrauterine growth restriction as a result of placental dysfunction. [1][2][3][4] For decades, traditional care practices for very low birth weight premature infants have been based in fluid and electrolyte restriction throughout the transition to extrauterine life until renal function was appropriately established, which usually takes 24-48 hours. [4][5][6] Today we know that these practices may lead to a decrease in plasma phosphorus levels, maximum renal tubular reabsorption of phosphorus, and hypercalcemia.…”

Section: Introductionmentioning

confidence: 99%