A cross-sectional analysis of factors associated with the development of refeeding syndrome in children 0 – 59 months diagnosed with severe acute malnutrition in a South African setting

Author:

Heydenrych Natalie,De Maayer Tim,Nel Mariette,van den Berg LouiseORCID

Abstract

AbstractBackgroundRefeeding syndrome (RFS) is a life-threatening, underdiagnosed, and under-researched complication in treating children with severe acute malnutrition (SAM). This study aimed to determine the incidence and onset of RFS and identify biochemical abnormalities, clinical signs, and complications associated with RFS development in children 0–59 months treated in a South African public hospital setting.MethodsA retrospective cohort study was performed on hospital files of children diagnosed with SAM at Rahima Moosa Mother and Child Hospital, Johannesburg, from 1/10/2014 to 31/12/2018. A total of 148 files could be retrieved from the hospital archives. The diagnosis of SAM based on the World Health Organization definition was confirmed in 126 of these children, and they were included in the study. The onset of RFS among the children included in the study was diagnosed based on published criteria for RFS. Children who developed RFS and those who did not were compared concerning biochemistry and clinical signs and symptoms on admission.ResultsThe median age of the 126 children (63% male) with confirmed SAM was 34 months (IQR: 26.0 to 48.4 months). The mortality rate was 18.2%. Of these children, 8.7% were retrospectively diagnosed as having developed RFS during their recorded hospital stay, despite implementing the WHO treatment guidelines for SAM. A significantly higher percentage of the children that developed RFS presented on admission with hypophosphatemia (p=0.04), severe hypokalemia (p=0.0005), hyponatremia (p=0.004), an international normalized ratio (INR) of above 1.7 (p=0.049), diarrhea (p=0.04), dehydration (p=0.02) and urinary tract infection (UTI) (p=0.04) than those that did not. Edema was more prevalent on admission in children who developed RFS than those who did not (63.6% vs 39.1%), though the difference was not statistically significant (p=0.20). Children who developed RFS stayed in hospital significantly longer than those who did not (18 vs 12 days) (p=0.003).ConclusionIn this population of children with SAM treated in a South African public hospital setting, the presence on hospital admission of low levels of electrolytes, elevated INR, dehydration, diarrhea, and UTI was significantly associated with developing RFS. Recognizing these as possible red flags for developing RFS in children admitted with SAM might contribute to improved outcomes and needs further investigation.

Publisher

Cold Spring Harbor Laboratory

Reference28 articles.

1. WHO. Updates on the management of severe acute malnutrition in infants and children [Internet]. Geneva: World Health Organization; 2013. Available from: http://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren/en/

2. Inpatient management of children with severe acute malnutrition: A review of WHO guidelines;Bull World Health Organ [Internet],2016

3. Incidence of refeeding syndrome and its associated factors in South African children hospitalized with severe acute malnutrition;Iran J Pediatr [Internet],2017

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3