People who are at risk of heart-related complications may require heart monitoring. Patients from ICU and those who were initially fed with more than 20kcal/kg/day showed a higher incidence of RH and RFS. 1 study [39] included only Caucasian participants however the majority of studies were conducted in affluent, Caucasian majority countries; 31% of the studies included were set in Australia, 14% in the USA, 10% in Canada. 2005;13(4):26472. A systematic review of the published literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [15]. Univariate, unadjusted long-term survival analysis revealed that lower MRA and lower SMI were associated with shorter survival (P=0.03). Refeeding may take up to 10 days, with monitoring afterward. Consequently, poor muscle status, determined by CT imaging, does not justify denying a patient an oncologic resection. WebIf the patient is considered to be at high risk of refeeding syndrome, the following steps are advised by NICE:1 Start nutrition support at a maximum of 10 kcal/kg/day, increasing levels slowly to meet or exceed full needs by four to seven days. The new guidelines give explicit clinical criteria for patients at risk and highly at risk of developing refeeding syndrome, enabling better identification and prevention 2023 BioMed Central Ltd unless otherwise stated. This is a secondary analysis of the PEPaNIC randomized controlled trial (N=1440), which showed that withholding supplemental parenteral nutrition (PN) for 1 week (late-PN) in the pediatric intensive care unit (PICU) accelerated recovery and reduced new infections compared to early-PN (<24h). Preventative therapies: Thiamine 100-200 mg q12-24. Effect sizes were expressed as 95% confidence intervals (CIs) and calculated using random-effects models. If youre recovering from an eating disorder or wanting a more positive relationship to food, these apps can. Agostino and colleagues [23] demonstrated that YP on medical wards having NG feeds had a mean LOS of 33.8days compared to those in the same setting having an oral diet who had a mean of 50.9days, however, the oral diet was lower in calories therefore taking longer for weight recovery and medical stabilisation. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. This leads to another condition called hypophosphatemia (low phosphate). Low baseline levels of K/Phos/Mg. 3729-3740, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. Nehring and colleagues [37] concluded that NG feeding had no impact on growth, recovery or development of psychiatric co-morbidities. Restore circulatory volume and monitor fluid balance and overall clinical status closely. WebRefeeding syndrome consists of metabolic changes that occur on the reintroduction of nutrition to in those who are malnourished or in the starved state (Figure 1). This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Higher caloric refeeding is safe in hospitalised adolescent patients with restrictive eating disorders. Together, these processes can lead to decreased concentrations of minerals in the blood, of which hypophosphatemia is the most characteristic [14]. Refeeding syndrome results from underfeeding for a period of time, followed by re-initiation of nutritional support (including enteral nutrition, parenteral nutrition, or even IV dextrose). Our results suggest that a robust model might be built, but requires a prospective study including a larger number of patients. Dysphagia or hyperemesis. 85% were at risk of RFS by National Institute for Health and Care Excellence (NICE) criteria. Last medically reviewed on January 6, 2020. Most EDs will be treated in an outpatient setting with hospitalisation generally reserved for those with severe malnutrition resulting in physical symptoms such as bradycardia, hypotension or dehydration as set out in the MARSIPAN guidance [16]. Disordered eating is often misunderstood. statement and Paediatr Child Health. Eur Child Adolesc Psychiatry. Kezelman S, Crosby RD, Rhodes P, Hunt C, Anderson G, Clarke S, et al. People who are malnourished are at risk. In addition, refeeding often occurs alongside other serious conditions that typically require simultaneous treatment. After electrolyte levels stabilize, increase caloric intake to 40 kCal/hr for a day, then increase to 60 kCal/hr for a day. NOTE: Many sources recommend starting conservatively (e.g., 50% energy requirement), with gradual advancement. Although there are some RCTs examining aspects of NG use in YP with ED the majority of studies were retrospective cohorts or case series. More well-designed randomized controlled trials are needed to explore the effect of calorie intake during refeeding. A review conducted by Rizzo and colleagues [49] (2019), which focused on NG for acute refeeding, also found a wide variety of practices. Figure1 displaying PRISMA flowchart of methodology utilised to search databases for this systematic review of enteral feeding in young people with restrictive eating disorders. Until recently, refeeding syndrome (RFS) has lacked standardized diagnostic criteria. STAR GC is most effective when nutrition and insulin are modulated together with timely responsiveness to persistent hyperglycaemia. 1). Medical wards used continuous feeding more frequently than MH wards, however this tended to be for a short period of time while the YP was medically unstable, after this they would be transitioned to an oral diet [22, 23, 25, 26]. A subset of patients receiving high glucose nutrition under IO were persistently hyperglycaemic, indicating patient-specific glucose tolerance. Previous reviews [32, 33] have examined use of NG feeding in ED, including the safety and efficacy of NG feeding as well as short-term and long-term outcomes. Couturier J, Mahmood A. Refeeding syndrome is a severe complication of refeeding in people with malnutrition, it includes a series of electrolyte disorders and clinical symptoms. A total of 4679 records were identified in the initial literature search. In the subgroup analyses, inpatients from Intensive Care Units (ICUs) and those initially fed with >20kcal/kg/day seemed to have a higher incidence of both RFS (pooled incidence=44%; 95% CI 36%52%) and RH (pooled incidence=27%; 95% CI 21%34%). JPEN J Parenter Enteral Nutr. 2 of these studies [24, 26] for the first 2472h started with continuous NG feeding, using higher than standard calorie protocols, 24003000kcal per day prevented any initial drop in weight. 8600 Rockville Pike The search criteria was peer reviewed by a researcher from the University of Yorks Child and Adolescent Mental Health Intervention Centre. The use of enteral nutrition in the treatment of eating disorders: a systematic review. Baseline demographic, comorbidity and preadmission caloric data were collected. Nutr Clin Pract. To keep this page small and fast, questions & discussion about this post can be found on another page here. Rizzo SM, Douglas JW, Lawrence JC. Sodium (salt) replacement may also be carefully monitored. Int J Eat Disord. The incidence of refeeding syndrome is difficult to determine, as there isnt a standard definition. WebThe current NICE guidelines poorly predict the occurrence of RH, and modification is likely beneficial. The PRISMA flowchart was used (Fig. Nurse estimated caloric intake was compared with digital before and after meal images. 2017;31(45):427. However, further research is required to assess the optimum NG feeding regime for YP at different levels of RS risk. Whitelaw M, Gilbertson H, Lam PY, Sawyer SM. For patients with the highest risk of refeeding syndrome, starting with 5 kcal/kg/day might even be considered (e.g., for a patient with BMI <14 kg/m2 and no nutritional intake for two weeks). (3) Absence of another obvious cause of hypophosphatemia that is felt to account for the hypophosphatemia. Anorexia nervosa, anxiety, and the clinical implications of rapid refeeding. The This review describes the large differences in the use of NG for YP with ED in medical and psychiatric wards in a number of countries globally. Earley T. Improving safety with nasogastric tubes: a whole-system approach. Overall, these manifestations are variable and insensitive tools for detecting refeeding syndrome. 1 Malnourished Correspondence to These studies discussed ceasing NG feeds after the risk of RS had reduced; most gave a time frame between 2 and 14days [24, 44]. Paccagnella A, Mauri A, Baruffi C, Berto R, Zago R, Marcon ML, et al. Refeeding syndrome commonly occurs in populations at high risk for malnutrition ranging from patients with eating disorders to renal failure patients on Birmingham CL, Su J, Hlynsky JA, Goldberg EM, GAO M. The mortality rate from anorexia nervosa. Finally, factors associated with the incidence of RFS, such as its definition, study design, type of population, age, initial caloric intake, and type of feeding were assessed by subgroup analysis. NG feeding is a safe and efficacious method of increasing total calorie intake by either supplementing oral intake or continuously. Article Copyright 2009-. The majority commenced on daily intake of less than 2000kcal and increased periodically. You may be at risk if one or more of the following statements apply to you: You may also be at risk if two or more of the following statements apply to you: If you fit these criteria, you should seek emergency medical care immediately. (2016). We noted that despite RH being common in inpatients with PEM+TB given high caloric diets, RFS was not detected. As a library, NLM provides access to scientific literature. Google Scholar. Cumulated insulin dose between days 5 and 9 was correlated to EGP at day 10 (R=0.55, P=0.03). Eat Disord. The refeeding syndrome (RFS) has been recognized as a potentially life-threatening metabolic complication of re-nutrition, but the definition widely varies and, its incidence is unknown. Am J Psychiatry. In studies where continuous NG was provided, YP were sometimes not given the option of an oral diet so that their calorie intake could be closely monitored [22,23,24, 31]. 3677-3687, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. Other metabolic changes can also occur. https://doi.org/10.1080/10640260902991236. In this study the mean LOS was significantly increased: 117days for YP managing oral intake compared to 180days for those requiring NG. Burden of eating disorders in 5-13-year-old children in Australia. It is evident that there is a wide variety of practices regarding implementation and regime of NG feeding in YP with eating disorders globally [9]. Are muscle parameters obtained by computed tomography associated with outcome after esophagectomy for cancer? Akgul S, Pehlivanturk-Kizilkan M, Ors S, Derman O, Duzceker Y, Kanpur N. Type of setting for the inpatient adolescent with an eating disorder: are specialized inpatient clinics a must or will the pediatric ward do? Rhabdomyolysis can occur (causing an elevated creatinine kinase). Shifts in electrolyte levels can cause serious complications, including seizures, heart failure, and comas. 2016;49(3):293310. Nasogastric tube feeding in line with new dietetic guidelines for the treatment of anorexia nervosa in a specialist children and adolescent inpatient unit: a case series. J Nutr Metab. However, due to the high heterogeneity of data, summary incidence measures are meaningless.

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