Hypophosphatemia in Refeeding Syndrome in Intrauterine Growth Restricted IUGR Neonates Who are Receiving Nutrition: A Prospective Observational Study

Objective: Electrolyte dysregulations particularly hypophosphatemia and hypokalemia following feeds in a starved person is known as refeeding syndrome, which may lead to life-threatening conditions like arrhythmias, heart failure, respiratory and neuromuscular compromise. To evaluate electrolyte dyscrasias following enteral or parenteral feeding, among intrauterine growth retardation (IUGR) neonates ie those who were starved in-utero, compared to non-IUGR neonates this study was planned.

Methodology: From March to August 2015, 60 IUGR and non-IUGR neonates who were admitted at birth before starting of nutrition, either by breast milk or electrolyte-free intravenous fluid. An infant was classified as IUGR when his birth weight was <10th percentile according to Fenton or Lubchenco growth charts. Venous blood was collected from intramural babies at zero hours of life or just before starting feeds to determine the basal level of serum electrolytes – phosphorus, magnesium and potassium, and was repeated in the following 48 and 72 hours.

Results: There was no significant difference between the two groups based on sex, history of maternal pre-eclampsia and oligohydramnios. At 72 hours after the start of feeding, Hypophosphatemia was significantly more prevalent, in 33.33% of IUGR vs. 2% of the non-IUGR group, [RR-5, p = 0.010]. Hypokalemia 20% IUGR; 1% non-IUGR group, [RR-6, p = 0.103]. Hypomagnesemia 3% IUGR; 2% non-IUGR group, [RR-1.5, p = 0.640]. Combined electrolyte– hypophosphatemia with hypokalemia (6.6%) and hypophosphatemia with Hypomagnesemia (13.3%), were present only in the IUGR group. Hyperglycemia was not present in any neonate.

Conclusions: IUGR neonates are more likely to develop Refeeding syndrome when compared to non-IUGR babies, manifesting as decreased phosphorus, potassium and magnesium levels. Phosphorous should be a part of feeding nutrition in IUGR babies.