Abbas Fatima, Vacheron Charles-Hervé, Duclos Antoine, Touzet Sandrine, Restier Liora, Duclaux-Loras Rémi, Restier Lauria, Marotte Stéphanie, Sierra Anaïs, Eid Bassam, Duclaux Irène Loras, Poinsot Pierre, Peretti Noël
Hospices Civil de Lyon, Hôpital Femme Mère Enfant, Service de Gastroentérologie, Hépatologie et Nutrition Pédiatriques, BRON, France.
Département d'Anesthésie Réanimation, Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France.
J Pediatr Gastroenterol Nutr. 2025 Apr;80(4):695-704. doi: 10.1002/jpn3.12466. Epub 2025 Jan 28.
Refeeding syndrome (RS) defines the deleterious clinical and metabolic changes occurring during nutritional support of severely malnourished patients. Pediatric guidelines to prevent and treat RS are scarce and highly variable. This study aimed to evaluate the effectiveness and safety of an enteral refeeding protocol in severely undernourished hospitalized children with anorexia nervosa (AN) or organic diseases (OD).
This ancillary study to the Preventing Malnutrition and Restoring Nutritional Status in Hospitalized Children (PREDIRE) trial (NCT01081587), included severely undernourished children hospitalized between January 2010 and June 2018 and treated with an enteral refeeding protocol drafted for the study. The effectiveness was assessed by weight gain and safety by clinical and laboratory abnormality occurrence over the initial 3-week refeeding period, which represents the most critical period for the development of RS.
After 3 weeks of refeeding, the mean weight for height ratio increased from 72% to 82%, and half of the patients with severe undernutrition improved their nutritional status. The prevalence of RS was 10.4%. No clinical cardiac or neurological complication occurred. The most frequent laboratory complication was hypophosphatemia in 13.7% of patients; but symptomatic in only two patients (2.5%). Compared with patients with OD, patients with AN improved their weight-for-height ratio faster without significantly more frequent complications, except for hepatic cytolysis which was less prevalent in AN (8.3% vs. 36.8%).
The proposed enteral refeeding protocol appears safe for treating severely undernourished children of different etiologies, with a low prevalence of RS and half of the patients recovered from severe malnutrition within a 3-week period.
再喂养综合征（RS）指的是在对严重营养不良患者进行营养支持期间发生的有害临床和代谢变化。关于预防和治疗RS的儿科指南稀缺且差异很大。本研究旨在评估一种肠内再喂养方案对患有神经性厌食症（AN）或器质性疾病（OD）的严重营养不良住院儿童的有效性和安全性。
这项针对“住院儿童预防营养不良和恢复营养状况（PREDIRE）试验”（NCT01081587）的辅助研究，纳入了2010年1月至2018年6月期间住院的严重营养不良儿童，并采用了为该研究起草的肠内再喂养方案进行治疗。有效性通过体重增加来评估，安全性通过最初3周再喂养期内临床和实验室异常的发生情况来评估，这3周是RS发生的最关键时期。
再喂养3周后，平均身高体重比从72%增至82%，半数严重营养不良患者的营养状况得到改善。RS的发生率为10.4%。未发生临床心脏或神经并发症。最常见的实验室并发症是低磷血症，发生率为13.7%；但只有两名患者（2.5%）出现症状。与OD患者相比，AN患者的身高体重比改善更快，并发症发生率没有显著增加，但肝细胞溶解在AN中发生率较低（8.3%对36.8%）。
所提出的肠内再喂养方案对于治疗不同病因的严重营养不良儿童似乎是安全的，RS发生率低，半数患者在3周内从严重营养不良中恢复。
