Preterm infant nutrition: considerations for infants at risk of refeeding syndrome

Area of Science:

• Neonatology
• Pediatric Nutrition
• Metabolic Disorders

Background:

• Refeeding syndrome (RS) is a critical concern in preterm infants with fetal malnutrition, often linked to placental insufficiency.
• Infants experiencing growth restriction or small for gestational age status are particularly vulnerable to RS.
• RS involves complex physiological adaptations and nutrient imbalances, potentially leading to severe, life-threatening outcomes.

Purpose of the Study:

• To review the physiology and metabolism of refeeding syndrome in preterm infants.
• To provide insights into the clinical monitoring and nutritional management strategies for infants at risk of RS.

Main Methods:

• Literature review focusing on the pathophysiology of RS in preterm neonates.
• Analysis of metabolic adaptations and biochemical abnormalities associated with RS.
• Synthesis of current clinical practices for nutritional support in at-risk infants.

Main Results:

• RS is characterized by significant electrolyte shifts and metabolic derangements following nutritional repletion.
• Early identification of risk factors like fetal malnutrition and growth restriction is crucial.
• Adverse clinical outcomes can be severe, including cardiac and respiratory complications.

Conclusions:

• Careful monitoring and tailored nutritional management, including parenteral and enteral nutrition, are essential to mitigate RS.
• Understanding the underlying physiology and metabolism is key to optimizing clinical care.
• Proactive management strategies can significantly improve outcomes for preterm infants susceptible to refeeding syndrome.