Prevalence, risk factors, and outcomes of refeeding-like syndrome in very low birth weight infants: A descriptive study
Allison Fialkowski1, Hunter Pepin2, Deirdre Ellard2
1Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Refeeding-like syndrome (RLS) is common in very low birth weight infants, especially those born prematurely or with impaired growth. Early screening and prevention are crucial for better outcomes in these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Critical Care Medicine
Background:
- Refeeding-like syndrome (RLS) is a known complication in very low birth weight (VLBW) infants receiving parenteral nutrition.
- Limited data exists on the prevalence, risk factors, and outcomes of RLS in this population.
Purpose of the Study:
- To determine the prevalence and risk factors of RLS in VLBW infants.
- To investigate the association of RLS with infant characteristics and clinical outcomes.
Main Methods:
- A single-center descriptive cohort study included 739 VLBW infants.
- Co-primary outcomes: RLS (serum phosphate <4 mg/dL) and severe RLS (serum phosphate <2.5 mg/dL) within the first week of life.
- Logistic regression was used to analyze associations between RLS, gestational age, fetal growth, maternal hypertension, and infant morbidities.
Main Results:
- RLS affected 36.6% of VLBW infants, with severe RLS in 6.6%.
- Lower gestational age (<27 weeks) and being small for gestational age (SGA) significantly increased RLS odds.
- Maternal hypertension was also associated with higher RLS risk. RLS correlated with increased odds of severe intraventricular hemorrhage and retinopathy of prematurity.
Conclusions:
- RLS is prevalent in VLBW infants, particularly those with prematurity and impaired fetal growth.
- RLS is linked to significant neonatal morbidities.
- Findings highlight the need for RLS screening and preventive measures in VLBW infants.
Background:
Refeeding-like syndrome (RLS) occurs in very low birth weight (VLBW) (<1500 g) infants receiving parenteral nutrition. Little is known about prevalence, risk factors, or outcomes.
Methods:
We performed a single-center descriptive cohort study in 739 VLBW infants born between October 2016 and December 2023. The co-primary outcomes were RLS during the first week of life (any serum phosphate <4 mg/dL [<1.29 mmol/L]) and severe RLS (<2.5 mg/dL [<0.81 mmol/L]). We also examined clinical outcomes associated with RLS, as well as associations of infant gestation length, fetal growth, and maternal hypertensive disorders with RLS outcomes, as well as associations of RLS with infant outcomes, adjusting for covariates in logistic regression.
Results:
Mean (standard deviation, SD) gestational age was 29.1 (2.8) weeks, 174 (23.5%) infants were small for gestational age (SGA), 36.6% had RLS, and 6.6% had severe refeeding-like syndrome (sRLS). Maternal hypertension was associated with higher odds of RLS (unadjusted odds ratio [OR] 1.8; 95% CI: 1.3, 2.4). Having gestational age <27 + 0 weeks (adjusted OR [aOR] 1.8; 95% CI: 1.2, 2.6) and being small for gestational age (aOR: 4.62; 95% CI: 3.2, 6.6) both increased the odds of RLS. Refeeding-like Syndrome was associated with higher odds of severe intraventricular hemorrhage and severe retinopathy of prematurity.
Conclusions:
Refeeding-like syndrome is common among VLBW infants, particularly those born with lower gestational age and impaired fetal growth, and may contribute to morbidities associated with VLBW infants. These findings support the importance of screening and preventive strategies.
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