Incidence and Risk Factors of Refeeding Syndrome in Preterm Infants

Area of Science:

• Neonatalogy
• Pediatric Critical Care
• Nutritional Science

Background:

• Refeeding syndrome (RFS) poses a significant risk to vulnerable preterm infants.
• Early nutritional support is crucial for growth but can precipitate metabolic complications.
• Identifying risk factors for RFS in extremely preterm infants is essential for proactive management.

Purpose of the Study:

• To determine the incidence of refeeding syndrome (RFS) in preterm infants (≤32 weeks gestational age) within the first week of life.
• To identify key risk factors associated with the development of RFS in this population.
• To inform clinical practice regarding the prevention and management of RFS in neonatal intensive care units (NICUs).

Main Methods:

• Retrospective analysis of 760 preterm infants (gestational age ≤32 weeks, birth weight <1500 g) admitted to a level III NICU.
• Data collected on infants receiving parenteral nutrition between January 2015 and April 2024.
• Modified log-Poisson regression with generalized linear models and robust variance estimation used to analyze risk factors.

Main Results:

• A total of 289 infants (38%) developed RFS.
• Male sex (aRR 1.31) and intraventricular hemorrhage (IVH) (aRR 1.71) were significantly associated with increased RFS risk.
• Higher sodium phosphate intake was associated with a significantly lower RFS risk (aRR 0.67).

Conclusions:

• Preterm infants ≤32 weeks gestational age exhibit a substantial incidence of RFS.
• Male sex, IVH, and low sodium phosphate levels are significant risk factors for RFS development.
• Further research into refined diagnostic criteria and targeted interventions for RFS in preterm neonates is warranted.