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Severe acute malnutrition (SAM) poses a significant public health challenge, particularly in low- and middle-income countries, where it is associated with high mortality rates. The World Health Organization (WHO) defines SAM as severe undernutrition, classified by weight-for-length/height <−3 standard deviations (SD) according to the WHO growth standards, mid-upper arm circumference (MUAC) <115 mm, or the presence of bilateral pitting edema. Children with SAM require urgent care, including nutritional intervention. However, too rapid reintroduction of nutrition can result in refeeding syndrome (RFS), a life-threatening complication with onset usually within 5 days of starting nutritional therapy. RFS is characterized by severe metabolic disturbances, including hypophosphatemia, hypokalemia, hypomagnesemia, and thiamine deficiency, resulting from the sudden reintroduction of nutrition following prolonged starvation. The pathophysiology of RFS is complex, involving shifts in electrolytes and fluids that can lead to cardiac, respiratory, neurological, and other systemic complications. This chapter explores the physiology, risk factors, clinical manifestations, prevention, and management strategies for RFS, emphasizing the critical importance of a cautious and well-monitored refeeding process in the recovery of children with SAM. Current guidelines recommend starting nutrition at low-energy levels and gradually increasing caloric intake while closely monitoring electrolyte levels to prevent RFS. Despite the established protocols, the incidence of RFS in pediatric patients remains underdiagnosed and underreported, largely due to the lack of unifying diagnostic criteria and awareness among clinicians. Moreover, current WHO guidelines for the dietary treatment of SAM and published guidelines for the prevention of RFS in the clinical setting are incongruent, and very few studies to date have investigated the incidence of RFS in SAM. This underscores the need for further research and evidence-based guidelines to optimize the management of SAM and prevent RFS-related mortality. Effective refeeding strategies are crucial in reducing the burden of malnutrition and improving the overall outcomes in vulnerable pediatric populations.

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Refeeding Syndrome in the Management of Pediatric Severe Acute Malnutrition

  • 动态工具书词条

  • 发表日期：

    2025年

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  • Louise van den Berg,
  • Natalie Heydenrych,
  • Tim de Maayer

摘要

Severe acute malnutrition (SAM) poses a significant public health challenge, particularly in low- and middle-income countries, where it is associated with high mortality rates. The World Health Organization (WHO) defines SAM as severe undernutrition, classified by weight-for-length/height <−3 standard deviations (SD) according to the WHO growth standards, mid-upper arm circumference (MUAC) <115 mm, or the presence of bilateral pitting edema. Children with SAM require urgent care, including nutritional intervention. However, too rapid reintroduction of nutrition can result in refeeding syndrome (RFS), a life-threatening complication with onset usually within 5 days of starting nutritional therapy. RFS is characterized by severe metabolic disturbances, including hypophosphatemia, hypokalemia, hypomagnesemia, and thiamine deficiency, resulting from the sudden reintroduction of nutrition following prolonged starvation. The pathophysiology of RFS is complex, involving shifts in electrolytes and fluids that can lead to cardiac, respiratory, neurological, and other systemic complications. This chapter explores the physiology, risk factors, clinical manifestations, prevention, and management strategies for RFS, emphasizing the critical importance of a cautious and well-monitored refeeding process in the recovery of children with SAM. Current guidelines recommend starting nutrition at low-energy levels and gradually increasing caloric intake while closely monitoring electrolyte levels to prevent RFS. Despite the established protocols, the incidence of RFS in pediatric patients remains underdiagnosed and underreported, largely due to the lack of unifying diagnostic criteria and awareness among clinicians. Moreover, current WHO guidelines for the dietary treatment of SAM and published guidelines for the prevention of RFS in the clinical setting are incongruent, and very few studies to date have investigated the incidence of RFS in SAM. This underscores the need for further research and evidence-based guidelines to optimize the management of SAM and prevent RFS-related mortality. Effective refeeding strategies are crucial in reducing the burden of malnutrition and improving the overall outcomes in vulnerable pediatric populations.