Srpski arhiv za celokupno lekarstvo 2024 Volume 152, Issue 3-4, Pages: 218-223
https://doi.org/10.2298/SARH230725029S
Full text (
551 KB)
Identification and prevention of refeeding syndrome in pediatric intensive care
Stević Marija 
(University of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Children´s Hospital, Belgrade, Serbia)
Vlajković-Ivanović Ana (University Children´s Hospital, Belgrade, Serbia), anavlajkovic1@gmail.com
Petrov-Bojičić Ivana (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Children´s Hospital, Belgrade, Serbia)
Ristić Nina (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Children´s Hospital, Belgrade, Serbia)
Budić Ivana (University of Niš, Faculty of Medicine, Niš, Serbia + University Clinical Centre of Niš, Clinic for Anesthesia and Intensive Therapy, Niš, Serbia)
Marjanović Vesna (University of Niš, Faculty of Medicine, Niš, Serbia + University Clinical Centre of Niš, Clinic for Anesthesia and Intensive Therapy, Niš, Serbia)
Simić Dušica (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Children´s Hospital, Belgrade, Serbia)
“Refeeding syndrome” is described in the literature as a range of metabolic and electrolyte disorders that result from starting nutritional rehabilitation in malnourished patients. Without a universally accepted definition, data on “refeeding syndrome” incidence are heterogeneous. In most cases, a clinician will subjectively identify “refeeding syndrome,” many authors have developed their purposes and criteria for it in their studies. Using the PubMed database and the appropriate filters (“refeeding syndrome”-related terms: refeeding syndrome, pediatrics, child, nutrition support, nutrition assessment, malnutrition), a search of the published literature was conducted. The American Society for Parenteral and Enteral Nutrition’s 2020 recommendations are the only guidelines for identifying children with or at risk for “refeeding syndrome”. High-quality scientific evidence regarding the clinical syndrome is absent, so we need further research in all “refeeding syndrome”-related areas, from validation to better identification of risk factors, definitions of “refeeding syndrome,” and standardization of treatment protocols. For now, clinicians must remain vigilant to protect patients from the potentially devastating consequences of the “refeeding syndrome.”
Keywords: refeeding syndrome, child, nutrition support, nutrition assessment, malnutrition
Show references
Corsello A, Trovato CM, Dipasquale V, Bolasco G, Labriola F, Gottrand F, et al. Refeeding Syndrome in Pediatric Age, An Unknown Disease: A Narrative Review. J Pediatr Gastroenterol Nutr. 2023;77(6):e75-e83. [DOI: 10.1097/MPG.0000000000003945] [PMID: 37705405]
Persaud-Sharma D, Saha S, Trippensee AW. Refeeding Syndrome. 2022 Nov 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. [PMID: 33232094]
Keys A, Brožek J, Henschel A, Mickelsen O, Longstreet Taylor H. The Biology of Human Starvation. Vol. 1. pp. xxxii + 764. Vol. 2. pp. viii + 765-1386. (Minneapolis: University of Minnesota Press; London: Oxford University Press, 1950)
Coe ME, Castellano L, Elliott M, Reyes J, Mendoza J, Cheney D, et al. Incidence of Refeeding Syndrome in Children With Failure to Thrive. Hosp Pediatr. 2020;10(12):1096-101. [DOI: 10.1542/ hpeds.2020-0124] [PMID: 33168566]
Mosuka EM, Murugan A, Thakral A, Ngomo MC, Budhiraja S, St Victor R. Clinical Outcomes of Refeeding Syndrome: A Systematic Review of High vs. Low-Calorie Diets for the Treatment of Anorexia Nervosa and Related Eating Disorders in Children and Adolescents. Cureus. 2023;15(5):e39313. [DOI: 10.7759/ cureus.39313] [PMID: 37351245]
McKnight CL, Newberry C, Sarav M, Martindale R, Hurt R, Daley B. Refeeding Syndrome in the Critically Ill: a Literature Review and Clinician’s Guide. Curr Gastroenterol Rep. 2019;21(11):58. [DOI: 10.1007/s11894-019-0724-3] [PMID: 31758276]
Ponzo V, Pellegrini M, Cioffi I, Scaglione L, Bo S. The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review. Intern Emerg Med. 2021;16(1):49- 60. [DOI: 10.1007/s11739-020-02525-7] [PMID: 33074463]
National Collaborating Centre for Acute Care. Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition. Available from: https://www.nice.org.uk/guidance/ cg32/chapter/1-Guidance#what-to-give-in-hospital-and-thecommunity. Accessed November 23, 2019.
da Silva JSV, Seres DS, Sabino K, Adams SC, Berdahl GJ, Citty SW, et al. Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract. 2020;35(2):178-95. [DOI: 10.1002/ncp.10474] Erratum in: Nutr Clin Pract. 2020;35(3):584-5. [PMID: 32115791]
Ong SH, Chen ST. Validation of Paediatric Nutrition Screening Tool (PNST) among Hospitalized Malaysian Children. J Trop Pediatr. 2020;66(5):461-9. [DOI: 10.1093/tropej/fmz085] [PMID: 31943107]
Cioffi I, Ponzo V, Pellegrini M, Evangelista A, Bioletto F, Ciccone G, et al. The incidence of the refeeding syndrome. A systematic review and meta-analyses of literature. Clin Nutr. 2021;40(6):3688- 701. [DOI: 10.1016/j.clnu.2021.04.023] [PMID: 34134001]
Runde J, Sentongo T. Refeeding Syndrome. Pediatr Ann. 2019;48(11):e448-e454. [DOI: 10.3928/19382359-20191017-02] [PMID: 31710364]
Solomon SM, Kirby DF. The refeeding syndrome: a review. JPEN J Parenter Enteral Nutr. 1990;14(1):90-7. [DOI: 10.1177/014860719001400190] [PMID: 2109122]
Dunn RL, Stettler N, Mascarenhas MR. Refeeding syndrome in hospitalized pediatric patients. Nutr Clin Pract. 2003;18(4):327-32. [DOI: 10.1177/0115426503018004327] [PMID: 16215059]
Ichikawa G, Watabe Y, Suzumura H, Sairenchi T, Muto T, Arisaka O. Hypophosphatemia in small for gestational age extremely low birth weight infants receiving parenteral nutrition in the first week after birth. J Pediatr Endocrinol Metab. 2012;25(3-4):317-21. [DOI: 10.1515/jpem-2011-0485] [PMID: 22768663]
Boubred F, Herlenius E, Bartocci M, Jonsson B, Vanpee M. Extremely preterm infants who are small for gestational age have a high risk of early hypophosphatemia and hypokalemia. Acta Paediatr. 2015;104(11):1077-83. [DOI: 10.1111/apa.13093] [PMID: 26100071]
Bonsante F, Iacobelli S, Latorre G, Rigo J, De Felice C, Robillard PY, et al. Initial amino acid intake influences phosphorus and calcium homeostasis in preterm infants--it is time to change the composition of the early parenteral nutrition. PLoS One. 2013;8(8):e72880. [DOI: 10.1371/journal.pone.0072880] [PMID: 23977367]
Mizumoto H, Mikami M, Oda H, Hata D. Refeeding syndrome in a small-for-dates micro-preemie receiving early parenteral nutrition. Pediatr Int. 2012;54(5):715-7. [DOI: 10.1111/j.1442- 200X.2012.03590.x] [PMID: 23005906]
Petrov I, Budić I, Mandraš A, Stević M, Milenović M, Simić D. [Parenteral nutrition of pediatric patients]. Serb J Anesth Intensive Ther. 2015;37(1-2):45-52.
Seron-Arbeloa C, Labarta-Monzon L, Puzo-Foncillas J, Mallor- Bonet T, Lafita-Lopez A, Bueno-Vidales N, et al. Malnutrition Screening and Assessment. Nutrients. 2022;14(12):2392. [DOI: 10.3390/nu14122392] [PMID: 35745121]
Stevic M, Budic I, Ristic N, Nenadovic D, Bokun Z, Jovanovic B, et al. Toxic epidermal necrolysis in a child with lupus-associated pancreatitis. Rheumatol Int. 2017;37(7):1221-6. [DOI: 10.1007/ s00296-017-3677-6] [PMID: 28239770]
Walmsley RS. Refeeding syndrome: screening, incidence, and treatment during parenteral nutrition. J Gastroenterol Hepatol. 2013;28 Suppl 4:113-7. [DOI: 10.1111/jgh.12345] [PMID: 24251716]
Oliveira S. 50 Years Ago in The Journal of Pediatrics: Refeeding Syndrome Now and Then. J Pediatr. 2020;220:206. [DOI: 10.1016/j. jpeds.2020.01.042] [PMID: 32334664]
Petrov Bojičić I, Milojević I, Simić D, Stević M, Kalezić N. [Physiological differences between children and adults]. Serb J Anesth Intensive Ther. 2013;35(7-8):347-53.
Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorstde van der Schueren MA. Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005;24(1):75-82. [DOI: 10.1016/j.clnu.2004.07.015] [PMID: 15681104]
De Silva A, Smith T, Stroud M. Attitudes to NICE guidance on refeeding syndrome. BMJ. 2008;337(7661):a680. [DOI: 10.1136/ bmj.a680] [PMID: 18614493]
Vlajkovic A, Stevic M, Budic I, Marjanovic V, Jovanovski Srceva M, Ducic S, et al. Acute respiratory distress syndrome: Is the concept of protective ventilation and driving pressure the real future? Macedonian Journal of Anaesthesia. 2019;7(11):41-7.
Marjanovic V, Budic I, Jankovic-Velickovic L, Stevic M, Kostic M, Simic D. Predictive Value of Neutrophil Count for Postoperative Complications in Children after Surgery of Perforated Appendicitis. Rev Romana Med Lab. 2021;29(1):77-84. [DOI: 10.2478/rrlm-2021-0008]
Wiley KD, Gupta M. Vitamin B1 (Thiamine) Deficiency. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. [PMID: 30725889]
Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition. 2001;17(7-8):632-7. [DOI: 10.1016/s0899- 9007(01)00542-1] [PMID: 11448586]
Cuerda C, Vasiloglou MF, Arhip L. Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa. J Clin Med. 2019;8(7):1042. [DOI: 10.3390/jcm8071042] [PMID: 31319585]
Friedli N, Stanga Z, Sobotka L, Culkin A, Kondrup J, Laviano A, et al. Revisiting the refeeding syndrome: Results of a systematic review. Nutrition. 2017;35:151-60. [DOI: 10.1016/j.nut.2016.05.016] [PMID: 28087222]
Blanc S, Vasileva T, Tume LN, Baudin F, Chessel Ford C, Chaparro Jotterand C, et al. Incidence of Refeeding Syndrome in Critically Ill Children With Nutritional Support. Front Pediatr. 2022;10:932290. [DOI: 10.3389/fped.2022.932290] [PMID: 35799690]
Goyale A, Ashley SL, Taylor DR, Elnenaei MO, Alaghband-Zadeh J, Sherwood RA et, al. Predicting refeeding hypophosphatemia: insulin growth factor 1 (IGF-1) as a diagnostic biochemical marker for clinical practice. Ann Clin Biochem. 2015;52(Pt 1):82-7. [DOI: 10.1177/0004563214523739] [PMID: 24609720]
Zeki S, Culkin A, Gabe SM, Nightingale JM. Refeeding hypophosphataemia is more common in enteral than parenteral feeding in adult in patients. Clin Nutr. 2011;30(3):365-8. [DOI: 10.1016/j.clnu.2010.12.001] [PMID: 21256638]