Prevalence of Refeeding Syndrome in a Pediatric Intensive Care Unit

Abstract

Refeeding syndrome (RS) is defined as a decrease in serum levels of phosphate, potassium, or magnesium, and/or organ dysfunction due to thiamine deficiency, occurring within the first 5 days after restarting feeding. It is an underdiagnosed entity with high morbidity and mortality, and its true incidence is unknown.

Objective: To estimate the prevalence of RS in a Pediatric Intensive Care Unit (ICU).

Patients and Method: Observational, descriptive, prospective study with convenience sampling. Patients aged 1 month to 18 years, admitted from May to October 2023, were included and clinically monitored for 5 days after resuming feeding. The severity of RS was classified according to the decrease in serum levels of phosphate, potassium, and/or magnesium (10-20% mild; 20-30% moderate; and over 30% severe). Statistical analysis was performed using the Chi-square test and Student’s T-test, with p < 0.05 considered significant. STATA v.15.0 software was used for the analysis.

Results: Out of the 343 patients admitted, 41% had some risk factor for RS, mainly critically ill and malnourished patients, with the most frequent reasons for admission being respiratory failure followed by septic shock. 81% of those with risk factors developed RS, and 44% had hypophosphatemia. Half of the malnourished patients had hypophosphatemia, and when severe, it was associated with higher mortality (p < 0.05).

Conclusion: A high percentage of patients developed RS, with 44% presenting hypophosphatemia, which agrees with international reports. Identifying patients at risk for RS allows for precautions in the initiation of feeding and avoiding this complication.