Incidence and risk factors for refeeding syndrome in the transition phase when treating children with severe acute malnutrition at Mwanamugimu Nutrition Unit, Mulago.

Abstract

ABSTRACT Background: Refeeding syndrome is a complication developed by children being managed for Severe acute malnutrition (SAM). It is caused by changes in electrolyte balance once high caloric feeding is reinitiated. Phosphorus, potassium, and magnesium are the main electrolytes affected when it occurs. However, hypophosphatemia is the hallmark of diagnosis of refeeding syndrome. WHO recommends inpatient management of patients with complicated SAM with initially F75 which is low in calories and later transitioned to RUTF which is high calories and but also has a higher phosphorus content. Objective: This study aimed to determine the incidence and risk factors for refeeding syndrome in the transition phase when treating children aged 6 to 59months with SAM at MNU, Mulago Methodology: We conducted a prospective cohort study at Mwanamugimu nutritional unit of Mulago national referral hospital. A total of 150 children between 6 to 59 months with SAM were enrolled in to the study. We measured serum electrolytes (phosphorus, sodium, potassium) at admission, initiation of RUTF and 48 hours after transition. Refeeding syndrome was diagnosed by a drop in serum phosphorus of more than 0.3mmol. The data was analyzed using STATA 13.0. Incidence of refeeding syndrome was determined as the proportion of participants with refeeding syndrome. For risk factors for, a multivariate COX regression analysis was performed with 0.2 level of significance at bivariate and 0.05 at multivariate analysis. Results: Of the 150 children recruited, 35 were lost to follow up and 115children had their data analyzed. Majority (55.7%) of the children were over 12 months, over 57% of the participants were male. Of the 115 participants in the study, 40 developed refeeding syndrome indicating a cumulative incidence of 1in 3. A low baseline sodium, pedal edema, and positive malaria test at admission were found to be risk factors for refeeding syndrome. Conclusion: The incidence of RFS of 1 in 3 children being managed for SAM is very high. Risk factors for RFS are; low baseline sodium, pedal edema and a positive malaria test at admission.