Refeeding Syndrome in Children Aged 6 to 59 Months with Severe Acute Malnutrition.

Objective: To assess the frequency and factors of refeeding syndrome in children aged 6 to 59 months with severe acute malnutrition (SAM).

Study design: Descriptive, cross-sectional study. Place and Duration of the Study: Department of Paediatric Medicine, Civil Hospital, Karachi, Pakistan, from April to September 2024.

Methodology: All children aged 6 to 59 months diagnosed with SAM, initially presenting with normal serum phosphate, potassium, and magnesium concentration and underwent nutritional rehabilitation within the initial 72 hours of hospital admission. Refeeding syndrome was defined as the sudden lowering of serum phosphate, potassium, and magnesium concentrations within 72 hours of initiating nutritional rehabilitation. Chi-square/Fisher's exact test and paired t-test were applied to assess associations and mean differences, considering p ≤0.05 as significant.

Results: The study included 185 children, with mean age of 23.94 ± 12.64 months, comprising of 104 (56.2%) boys and 81 (43.8%) girls. Refeeding syndrome was observed in 23 (12.4%) children. Children with refeeding syndrome showed significant declines in serum phosphate (3.68 ± 1.17 vs. 1.53 ± 0.49 mg/dL, p <0.001), potassium (3.92 ± 0.72 vs. 2.81 ± 0.66 mg/dL, p <0.001), and magnesium (2.02 ± 0.27 vs. 0.93 ± 0.22 mg/dL, p <0.001) levels from the baseline. Refeeding syndrome was significantly associated with younger age (p = 0.009), shorter height (p = 0.009), and the use of nasogastric or intravenous nutritional support (p = 0.012). Cardiac irregularities were more frequent in children with refeeding syndrome (p = 0.039).

Conclusion: Refeeding syndrome occurred in 12.4% of SAM children and was linked to younger age, shorter height, and nasogastric or intravenous feeding.

Key words: Refeeding syndrome, Severe acute malnutrition, Paediatrics, Electrolyte imbalance, Nutritional support.