Introduction:

nutrition is one of the fundamental pillars of the critically ill patients’ treatment. The initiation of feeding could lead those patients with risk factors to develop refeeding syndrome (RS). The American Society for Parenteral and Enteral Nutrition (ASPEN) defines this syndrome in its 2020 consensus as a decrease in serum phosphorus, potassium and/or magnesium and/or organic dysfunction due to a decrease in any of these and/or due to thiamine deficiency, which occurs within 5 days of restarting or increasing feeding. Despite being a widely described condition with high morbidity and mortality, it continues to be an underdiagnosed disease when not timely identified, with an unknown global incidence.

Objectives:

to estimate the prevalence of RS according to the ASPEN criteria at a pediatric intensive care unit (ICU) in May - July 2023.

Material and methods:

observational, descriptive, prospective study. A convenience sample was selected, including patients from 1 month to 18 years old, admitted to an ICU in May-July 2023 with risk factors for developing RS. Clinical and paraclinical follow-up was carried out for 5 days after restarting feeding and the variables of interest were collected.

Results:

during the study period, 160 patients were admitted to the ICU. Of these, 81 (51%) presented one or more risk factors for SR. The main risk factors were being part of the critically ill population (requiring respiratory or hemodynamic support) and malnutrition prior to admission (91% critically ill patients, 21% with malnutrition). The most common reason for admission was respiratory (68%), followed by sepsis/septic shock. Among patients with risk factors: 64 (79%) presented SR, defined as a decrease in potassium, magnesium and/or phosphorus. 27 (33%) had hypophosphatemia. 41% of the malnourished patients presented hypophosphatemia.

Conclusions:

a high percentage of the ICU patients presented RS, 33% if we consider only hypophosphatemia, and 51% of the patients admitted in the study period had risk factors for developing it. This figure coincides with that reported in other international studies. The ASPEN consensus definition is very sensitive and not very specific considering that it includes hypokalemia, which can be multifactorial. Recognizing patients at risk of RS and being aware of its definition enables us to take precautions when starting feeding and avoid this complication that can increase our patients’ morbidity and mortality.

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