Prevalence, risk factors, and outcomes of refeeding‐like syndrome in very low birth weight infants: A descriptive study

BACKGROUND: Refeeding-like syndrome (RLS) occurs in very low birth weight (VLBW) (<1500 g) infants receiving parenteral nutrition. Little is known about prevalence, risk factors, or outcomes. METHODS: We performed a single-center descriptive cohort study in 739 VLBW infants born between October 2016 and December 2023. The co-primary outcomes were RLS during the first week of life (any serum phosphate <4 mg/dL [<1.29 mmol/L]) and severe RLS (<2.5 mg/dL [<0.81 mmol/L]). We also examined clinical outcomes associated with RLS, as well as associations of infant gestation length, fetal growth, and maternal hypertensive disorders with RLS outcomes, as well as associations of RLS with infant outcomes, adjusting for covariates in logistic regression. RESULTS: Mean (standard deviation, SD) gestational age was 29.1 (2.8) weeks, 174 (23.5%) infants were small for gestational age (SGA), 36.6% had RLS, and 6.6% had severe refeeding-like syndrome (sRLS). Maternal hypertension was associated with higher odds of RLS (unadjusted odds ratio [OR] 1.8; 95% CI: 1.3, 2.4). Having gestational age <27 + 0 weeks (adjusted OR [aOR] 1.8; 95% CI: 1.2, 2.6) and being small for gestational age (aOR: 4.62; 95% CI: 3.2, 6.6) both increased the odds of RLS. Refeeding-like Syndrome was associated with higher odds of severe intraventricular hemorrhage and severe retinopathy of prematurity. CONCLUSIONS: Refeeding-like syndrome is common among VLBW infants, particularly those born with lower gestational age and impaired fetal growth, and may contribute to morbidities associated with VLBW infants. These findings support the importance of screening and preventive strategies.