597 - Risk of Refeeding Syndrome in Infants Admitted for Malnutrition

Publication Number: 2582.597

Michelle Dunn, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Levon H. Utidjian, Childrens Hospital of Philadelphia, Wynnewood, PA, United States; Jessica Hart, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Daria Ferro, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Irit R. Rasooly, Childrens Hospital of Philadelphia, Bala Cynwyd, PA, United States; Ao (Sophia) Tan, Childrens Hospital of Philadelphia, Lansdale, PA, United States

Background: Malnutrition (also known as failure to thrive) is a common indication for hospital admission in infants. Refeeding syndrome is a well described complication of restoring nutrition in patients admitted with malnutrition, and electrolytes are frequently monitored. However, the incidence of clinically significant refeeding syndrome in infants admitted primarily for malnutrition is unknown.

Objective: To determine the incidence of clinically significant refeeding syndrome in infants admitted with malnutrition.

Design/Methods: A retrospective chart review of children under 12 months admitted to a large children’s hospital with a primary admission or discharge diagnosis of malnutrition from July 1, 2015 to May 18, 2023 was performed. The primary outcome was evidence of clinically significant refeeding syndrome, defined as a patient requiring electrolyte supplementation, a change to their feeding plan, or a change in their clinical status due to electrolyte abnormalities from refeeding syndrome. Charts of all patients with either hypokalemia, hypophosphatemia, and/or hypomagnesemia were reviewed to determine if the patient had clinically significant refeeding syndrome or any adverse events related to electrolyte derangement. All fourteen-day readmissions in the cohort were reviewed to look for missed complications of refeeding syndrome.

Results: A total of 1040 admissions met inclusion criteria. 840 patients had electrolytes checked during their admission. Of these, 70 had hypophosphatemia, hypokalemia, or hypomagnesemia. Only 3 (3.4%) patients had evidence of clinically significant refeeding syndrome by requiring electrolyte supplementation. No patients had any severe complications of refeeding syndrome (severe electrolyte abnormalities requiring ICU transfer, cardiac dysfunction, or arrhythmia.) No patients in the cohort required readmission to the hospital within 14 days for treatment of refeeding syndrome.

Conclusion(s): In infants admitted with a primary diagnosis of malnutrition, refeeding syndrome requiring any change in clinical management is rare. Routine monitoring of electrolytes during nutritional rehabilitation may be unnecessary unless otherwise clinically indicated. Further quality improvement work will be needed to decrease unnecessary laboratory monitoring.

Figure 1: Chart Review Results
Chart Review Schematic.pdfFigure 1 showing distribution of the 1040 infants admitted for malnutrition studied. 840 had electrolytes done, with 70 meeting the laboratory criteria for hypokalemia, hypophosphatemia, or hypomagnesemia. Only 3 patients had clinical changes made based on their labs, with electrolyte supplementation started.