← Issue №4/ week of Jul 26, 2026/Nutrition

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

From GI Signals issue №4: what this paper found, what it changes, and where it sits against the current standard of care, reviewed by Simon Mathews, MD.

Nutrition retrospective · n=739 · Jul 26, 2026 · JPEN · IF 3.2

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

New evidencepediatricrefeeding syndromeparenteral nutrition
Clinical takeawayMonitor serum phosphate closely in VLBW infants (<1500 g), especially those <27 weeks gestation or small for gestational age, during the first week of parenteral nutrition to detect and manage RLS early. Consider preventive strategies (e.g., slower nutrient advancement) in high-risk infants.
What it found36.6% of very low birth weight (VLBW) infants developed refeeding-like syndrome (RLS, serum phosphate <4 mg/dL), and 6.6% had severe RLS (<2.5 mg/dL); SGA infants had 4.6x higher odds of RLS (95% CI: 3.2, 6.6), and RLS was associated with severe intraventricular hemorrhage and retinopathy of prematurity.
ContextConfirms and quantifies RLS risk in VLBW infants, previously understudied, and identifies high-risk subgroups (SGA, <27 weeks) with actionable associations to morbidity.
Reinforcessuggested applicable standard· ESPEN (European Society for Clinical Nutrition and Metabolism), "ESPEN guideline on chronic intestinal failure in adults, Update 2023," Clinical Nutrition, 2023

Decision at stakemonitor for refeeding syndrome in patients receiving parenteral nutrition

Manage short bowel syndrome / intestinal failure with a multidisciplinary IF team using a three-phase nutrition strategy: initiate TPN with IV hydration and electrolyte replacement in the acute hypersecretory phase, progressively advance enteral feeds and wean PN during the 1-2 year adaptation phase, then maintain an oral diet with selective PN as needed.

From our summary of this standard, unedited — the part the paper bears on. marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Manage short bowel syndrome / intestinal failure with a multidisciplinary IF team using a three-phase nutrition strategy: initiate TPN with IV hydration and electrolyte replacement in the acute hypersecretory phase, progressively advance enteral feeds and wean PN during the 1-2 year adaptation phase, then maintain an oral diet with selective PN as needed. In carefully selected PN-dependent patients, and only when prescribed by clinicians experienced in SBS/IF management (generally once the adaptation phase is complete), consider the GLP-2 analog teduglutide (0.05 mg/kg/day subcutaneously) to promote intestinal adaptation and reduce PN volume, but only after baseline screening to exclude neoplasia and contraindications (colonoscopy with removal of any polyps when colon and/or rectum is present, and assessment for active or recent [within 5 years] gastrointestinal, hepatobiliary, or pancreatic malignancy, which contraindicate its use) and with mandatory ongoing safety monitoring (surveillance colonoscopy after 1-2 years then every 5 years, plus vigilance for colorectal/GI polyps and neoplasia, intestinal obstruction, biliary/gallbladder and pancreatic disease, and fluid overload); add antimotility agents (loperamide, then codeine/opium tincture) for high-output stoma, and provide lifelong nutrient surveillance/supplementation (notably B12) plus monitoring for CRBSI, IFALD, oxalate stones, and refeeding syndrome.

ESPEN (European Society for Clinical Nutrition and Metabolism), "ESPEN guideline on chronic intestinal failure in adults, Update 2023," Clinical Nutrition, 2023 · reviewed 2026-07-23 ↗
Fialkowski A … Belfort MB · JPEN. Journal of Parenteral and Enteral Nutrition · IF 3.2 · PubMed ↗Permalink
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