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. 2024 Oct 11;16(20):3445.
doi: 10.3390/nu16203445.

Impact of Refeeding Syndrome on the Short-Term Clinical Outcomes of Very-Premature Infants

Mountasser M Al-Mouqdad  1 , Belal Alshaikh  2 , Haider H Sumaily  1 , Ameen A Almotiri  1 , Nabeel A Alodhaidan  1 , Latifah AlMahmoud  1 , Adli Abdelrahim  1 , Tamadur E Yousif  1 , Abdullah S Alghamdi  1 , Yasir A Albarrak  3 , Aljohara O Alnafiey  4 , Maha R Al-Anazi  4 , Thanaa M Khalil  5 , Raneem S Asfour  6 , Suzan S Asfour  7
Affiliations

Impact of Refeeding Syndrome on the Short-Term Clinical Outcomes of Very-Premature Infants

Mountasser M Al-Mouqdad et al. Nutrients. .

Abstract

Background: Refeeding syndrome (RFS) is a potentially life-threatening condition that can occur in preterm infants if nutritional support is initiated or increased after a period of starvation or malnutrition.

Objectives: The current study aimed to examine the short-term clinical outcomes of RFS in preterm infants born at ≤32 weeks of gestation.

Methods: Infants with a gestational age of ≤32 weeks and a birth weight of <1500 g who were born and admitted to the level III neonatal intensive care unit and received parenteral nutrition upon admission were retrospectively evaluated. The modified log Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the outcomes of infants.

Results: In total, 760 infants met this study's inclusion criteria. Of them, 289 (38%) developed RFS. RFS was significantly associated with a composite outcome of mortality and intraventricular hemorrhage. Based on the multivariate Cox regression analysis adjusted for significant potential confounders, RFS was significantly associated with increased mortality risk, with a hazard ratio for death in infants with RFS being 1.74-fold higher compared to those without RFS.

Conclusions: Preterm infants born at ≤32 weeks of gestation who develop RFS within the first week of life are at increased risk for both intraventricular hemorrhage and mortality. This study underscores the need for standardized clinical approaches for managing RFS in the neonatal intensive care unit to improve outcomes. Future research should establish a unified RFS definition and conduct clinical trials to optimize parenteral nutrition strategies for this vulnerable population.

Keywords: intraventricular hemorrhage; mortality; parenteral nutrition; preterm infants; refeeding syndrome.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of patient selection. GA gestational age.
Figure 2
Figure 2
Percentage of neonatal morbidities and mortality stratified according to RFS.
Figure 3
Figure 3
Kaplan–Meier curves showing the association between RFS and survival among infants aged < 32 gestational weeks, log-rank test, p < 0.001.
Figure 4
Figure 4
Kaplan–Meier curves showing the association between RFS and survival among infants aged < 28 gestational weeks, log-rank test, p < 0.001.
See this image and copyright information in PMC

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