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

BACKGROUND: Refeeding syndrome is characterized by metabolic disturbance including hypophosphatemia and hypokalemia upon reinstitution of nutrition in severely malnourished patients. OBJECTIVE: The present study sought to identify the risk factors for the development of refeeding syndrome-like metabolic disturbance in very low birth weight infants. METHODS: The correlations of severe hypophosphatemia with the serum levels of potassium and ionized calcium, daily calorie and phosphate intake, and umbilical cord blood flow on ultrasonography were analyzed in 49 very low birth weight infants. RESULTS: Fifteen infants (36%) presented with hypophosphatemia during the first postnatal week. Hypophosphatemia was significantly associated with birth weight z score (odds ratio, 1.60; 95% confidence interval, 1.04-2.47; p = 0.034) and umbilical artery resistance index (odds ratio, 7.72E-04; 95% confidence interval, 1.14E-06-0.523; p = 0.031). Multiple regression analysis revealed that umbilical artery resistance index was independently associated with hypophosphatemia. CONCLUSIONS: Umbilical artery resistance index may serve as a useful marker for future development of refeeding syndrome-like hypophosphatemia in very low birth weight infants. Close monitoring of serum phosphorus and potassium levels and early intervention are important for the management of very low birth weight infants with intrauterine growth restriction due to placental dysfunction.

Fósforo sérico en niños con desnutrición grave y su relación con el síndrome de realimentación / Serum phosphorus in malnourished children and its relationship with the syndrome of feedback

El síndrome de realimentación ocurre como consecuencia de la reintroducción de alimentos en pacientes malnutridos. Se realizó estudio de tipo observacional, prospectivo, no experimental y comparativo. Se midieron los niveles de fósforo en niños desnutridos graves y eutróficos al ingreso y al día 7 después de iniciada la alimentación con el objetivo de relacionar los niveles séricos de fósforo con el síndrome de realimentación en niños desnutridos graves atendidos en el Servicio de Emergencia de Pediatría Hospital Universitario de Maracaibo. Venezuela, desde junio 2010 hasta junio 2011. Se incluyeron 60 niños, entre 1 mes y 4 años, de ambos sexos, divididos en 2 grupos: Grupo A n=30 niños desnutridos graves y Grupo B n=30 niños eutróficos. En ambos grupos predominaron los lactantes de 1 a 23 meses con el 86,7% y el 60% respectivamente. Fueron del sexo masculino el 70% y 73% en cada grupo. El fósforo sérico en el grupo A al ingreso fue de 3,17 ± 0,98 mg/dl y a los siete días 2,48 ± 1,01 mg/dl, estadísticamente significativo p = 0,002; sin manifestaciones clínicas. En el grupo B no hubo significancia estadística con p=0,569 al comparar los valores del fósforo sérico al ingreso y al día 7. Tres niños del grupo A murieron. Se observo en el presente estudio que los niños desnutridos graves presentaron disminución del fósforo sérico al ser realimentados. Nuevas líneas de investigación deben hacerse para aumentar los conocimientos actuales sobre ésta condición(AU)

Refeeding syndrome occurs as a result of the reintroduction of food in malnourished patients. Observational, prospective, non experimental and comparative study was performed. Phosphorus levels in severely malnourished children and healthy children was measured at admission and at 7 days after initiation of feeding in order to associate the concentration of serum phosphorus with refeeding syndrome in severely malnourished children hospitalized at the Pediatric Emergency Service University Hospital of Maracaibo, Venezuela, from June 2010 to June 2011. We included 60 children between 1 month and 4 years and both sexes, divided into 2 groups: Group A n = 30 serious malnourished children and Group B (control) n = 30 eutrophic children. In both groups predominated the infants 1 to 23 months with 86.7% and 60% respectively. 70% and 73% were male both group. In Group A, there was statistical significance betwee the serum phosphorus at the beginning (3.17 ± 0.98 mg/dl) and at seven days of hospitalization 2.48 ± 1.01 mg/dl, p = 0.002; without clinical manifestations. In Group B there was no statistical significance with p=0,569 to compare values of serum phosphorus income and day 7. Three children of the group A died. It was observed in this study that serious malnourished children presented the serum phosphorus decreased to be refueled. New lines of research should be expanded in this area to increase current knowledge about this condition(AU)