Comprehensive assessments of incidence, risk factors and short-term outcomes of refeeding syndrome in small-for-gestational-age infants

Background Few studies have studied the refeeding syndrome (RS) in small-for-gestational-age SGA infants, which led to the lack of knowledge in this field. This study aimed to compressively assess the incidence, risk factors and short-term outcomes of RS in SGA infants in order to improve clinical managements of SGA infants. Methods This prospective cohort study enrolled hospitalized SGA infants who received enteral nutrition (EN) and/or parenteral nutrition (PN) within 24h upon admission and with complete clinical data from January 2019 to June 2024. RS was defined according to the ASPEN criteria and as a decrease of ≥ 10% in at least one of phosphorus, potassium and magnesium level during the first five days of EN and/or PN. Binary logistic regression analyses were performed to explore the independent risk factors of RS and associations between RS and short-term outcomes. Results 359 SGA infants were finally included in the study, comprising 175 (48.70%) males and 184 (51.30%) females. The incidence of RS was 203 (56.50%) in SGA infants. Binary logistic regression analyses revealed that high potassium level at baseline (adjusted odds ratio (OR) = 4.842, 95% confidence interval (CI): 2.947 to 7.955, P  < 0.001) and premature rupture of membrane (adjusted OR = 3.292, 95%CI: 1.459 to 7.429, P  = 0.004) were the independent risk factors for RS; older age (adjusted OR = 0.910, 95%CI: 0.859 to 0.963, P  = 0.001) and higher albumin level (adjusted OR = 0.891, 95%CI: 0.821 to 0.966, P  = 0.005) were the protective factors, and RS was the independent risk factors for neonatal sepsis (adjusted OR = 3.672, 95%CI: 1.193 to 11.301, P = 0.023) and thrombocytopenia (adjusted OR = 1.921, 95%CI: 1.023 to 3.606, P = 0.042). Conclusions There was a high RS incidence in SGA infants. High potassium level at baseline and premature rupture of membrane were the independent risk factors for RS, and RS was the independent risk factors for neonatal sepsis and thrombocytopenia. These findings suggested RS screening should be performed in routine clinical practice for all SGA infants, and timely monitoring and intervening in neonatal sepsis and thrombocytopenia in SGA infants with RS.