Refeeding Syndrome in the Neonatal Intensive Care Unit

Area of Science:

• Neonatal Medicine
• Clinical Nutrition
• Pediatric Critical Care

Background:

• Refeeding syndrome (RS) lacks clear definition in neonates, though hypophosphatemia is a frequent sign.
• Existing RS guidelines from ASPEN lack specific neonatal recommendations.
• Hypophosphatemia is the most common manifestation of RS in neonates.

Purpose of the Study:

• To review the incidence of RS and hypophosphatemia in neonates.
• To analyze patient-specific and nutritional factors impacting neonatal RS.
• To synthesize current literature on neonatal refeeding challenges.

Main Methods:

• Conducted a literature review of Medline, PubMed, and EPub (1946-2020).
• Included 16 studies encompassing 3688 neonates.
• Analyzed data on hypophosphatemia, hypokalemia, and hypomagnesemia incidence and influencing factors.

Main Results:

• Wide variation in hypophosphatemia (20%-90%), hypokalemia (8.8%-66.7%), and hypomagnesemia (1%-8.3%) incidence across studies.
• Significant heterogeneity in RS definitions, patient populations, and nutritional protocols complicated incidence determination.
• Hypophosphatemia linked to increased mechanical ventilation, bronchopulmonary dysplasia, and mortality.

Conclusions:

• Vigilant monitoring of serum phosphate, potassium, and magnesium is essential in the first week of life for neonates.
• Early phosphate supplementation (1:1 molar ratio with calcium) is recommended for high-risk neonates.
• Standardized definitions and protocols are needed for accurate neonatal RS assessment.