2009;190(8):4104. At day 10, VO2 (R=0.59, P=0.04) was correlated with GNG and VCO2 with EGP (R=0.85, P=0.00003). Clausen [46] described NG as the most frequently used involuntary measure in psychiatric practice and is most commonly used in 1517year olds. Quality assessment, including risk of bias, was conducted by all authors. Until recently, refeeding syndrome (RFS) has lacked standardized diagnostic criteria. (NICE Guideline, No. This lack of evidence was confirmed by another systematic review and meta-analysis published in 2021. WebThe NICE (National Institute for Health and Clinical Excellence) in England has listed criteria for identifying a patient who may be at increased risk for refeeding problems. Thiamine (e.g., 500 mg IV q8hr, if mental status changes). 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). Neither a relevant association of SMI nor MRA with pneumonia and esophagoenteric leak were observed. PubMed Both these pathways are dysregulated in acute stress, but the magnitude of this deregulation cannot be assessed in clinical practice. Identifying the associations between plasma SCFA levels and intronic DNA methylation of HIF3A may reveal useful predictors or provide insights into the disease processes of DCM. Psychiatric nursing assistants views centred around: NG being an unpleasant practice, becoming sensitized or desensitized, and the importance of developing coping mechanisms to manage the distress. Fiber intake depends on age, gender, and sex. It is not possible from these studies to make any comparison between NG feeding and oral intake due to the confounding effect that for the vast majority of studies only high risk, medically unstable YP were considered for NG feeding. A systematic review of enteral feeding by nasogastric tube in young people with eating disorders. There is no high-quality evidence on this. Later, diagnostic criteria and algorithms for the RFS diagnosis based on both electrolyte abnormalities and clinical manifestations have been proposed [5,10,11]. This definition is somewhat unique in its incorporation of potassium and magnesium changes. There was a wide variety in length of time receiving NG for medical instability. BMJ Open. 2020;34:3341. Aust N Z J Psychiatry. Nutrition support in adults | Quality standards | NICE. A number of YP in MH wards required restraint to NG feed with one study reporting this was required for 66% of YP [24]. https://doi.org/10.1002/eat.20164. However, it typically follows a period of: Certain conditions may increase your risk for this condition, including: Certain surgeries may also increase your risk. sharing sensitive information, make sure youre on a federal The incidence of RFS is at present uncertain due to heterogeneity of subjects involved and the lack of a universally accepted definition [3,4,7]. You might be at risk if you: Refeeding syndrome is a serious condition. KH gathered data and interpreted results. Advance diet gradually as tolerated. There are many vegan protein powders on the market, with a variety of flavors and ingredients available. Five studies used qualitative methods to analyse patient, parent and professional opinions on NG feeding [10, 20, 40, 45, 48]. Nehring I, Kewitz K, Von Kries R, Thyen U. There are a number of limitations to the conclusions that can be drawn from this review. Healthline Media does not provide medical advice, diagnosis, or treatment. https://doi.org/10.1007/s00787-008-0706-8. Whitelaw M, Gilbertson H, Lam PY, Sawyer SM. Part of Increase of parenteral nutrition intake (in % kcal of predicted resting energy expenditure) decreased phosphate concentrations (c=0.002 (95% CI -0.002;0.001). Check electrolytes (including magnesium and phosphate), with aggressive repletion as needed. Although complications such as electrolyte abnormalities did occur there was no evidence that this was attributable to the NG feeding compared to oral diet [9, 18, 23, 24]. To keep this page small and fast, questions & discussion about this post can be found on another page here. Routine NG feeding may allow greater initial caloric intake, which does not increase risk of medical complications, and may actually increase initial weight gain thus reducing time in hospital. However, this study does not discuss the reasons NG was implemented. WebBACKGROUND. There are clear risk factors for refeeding syndrome. Neiderman M, Zarody M, Tattersall M, Lask B. Enteric feeding in severe adolescent anorexia nervosa: a report of four cases. This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. Yet again, the incidence is Abstracts identified from the initial search were screened in a secondary review process, and full text papers were obtained of those meeting the inclusion criteria or where there was uncertainty. 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. Eur Child Adolesc Psychiatry. CF performed the discussion. occur in malnourished patients on refeeding following a period of starvation. Article Those studies where NG was used for medical stabilisation often described a short period of NG before a quick transition back to an oral diet [22, 23, 36]. https://doi.org/10.1155/2016/5168978. Roux H, Chapelon E, Godart N. Epidemiology of anorexia nervosa: a review. Structured, supported feeding admissions for restrictive eating disorders on paediatric wards. Terms and Conditions, The majority also had a relatively small sample size, again introducing the possibility of bias and reducing generalizability. https://doi.org/10.1002/erv.624. Maginot et al., 2017 [18] and Whitelaw et al., 2010 [9] reported NG bolus feeding in 13.8 and 15% in order to supplement oral diet with a mean weight gain of 3.1kgs and 2.6kgs respectively but did not report if this was specific to NG feeding. All authors assessed bias risk. The pooled impact of refeeding syndrome on length of stay of 2634 patients in 10 studies was weighted mean difference (WMD)=2.91 (95% CI,0.18 6.00; P=0.065) days. The full search is available in Appendix 1. The anabolic processes require minerals and coenzymes such as thiamine [4,6]. It seems logical to avoid administering insulin if possible (e.g., allowing glucose to rise to ~200-300 mg/dL). Three studies were qualitative interview studies, examining patient or staff feelings towards NG feeding in practice which increases the risk of confirmation bias. 2016;28(1):97105. For nocturnal feeds, oral diet was encouraged during the day. NG feeding is an important aspect of treatment for YP with ED who are medically unstable and/or unable to manage an adequate oral diet. The epigenetic regulation of the hypoxia-inducible factor 3A (HIF3A) gene is implicated in oxidative metabolism in the pathogenesis of diabetes. Neither of these guidelines are specific for children and adolescents. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436876/. Regulation of endogenous glucose production (EGP) is essential for glucose homeostasis. If phosphate falls <1.5 mg/dL (0.5 mM) this indicates refeeding syndrome > see treatment below. To analyze the relationship of lengths of stay to muscle parameters, the competing risk approach introduced by Fine and Gray was applied. However, if the analysis was adjusted for confounders, e.g., Charlson Comorbidity Index, no relevant association regarding long-term survival was detected. 2013;53(5):5904. Sodium (salt) replacement may also be carefully monitored. As per NICE guidelines, the care plan developed for each patient should specify how the patient will be discharged and reenter community-based care. Marianna Pellegrini: Data curation, Writing - Review & Editing. 2016;49(3):293310. London: National Institute for Health and Care Excellence (UK); 2017. Turk J Pediatr. McCray S, et al. Refeeding syndrome: A literature review. Cells need electrolytes like phosphate to convert glucose to energy, but phosphate is in short supply. The incidence of refeeding syndrome is difficult to determine, as there isnt a standard definition. Rizzo SM, Douglas JW, Lawrence JC. Eighteen studies involving 3868 participants were included in our review. No unequivocal policy on how to start and progress with HPN has ever been presented. specialist registrar gastroenterology and clinical nutrition. 2004;25(6):4158. DOI: Khan LUR, et al. Source: Garber AK, Cheng J, Accurso EC, et al. and transmitted securely. It comes after a rigorous review process. The incidence rate of both RFS and RH greatly varied according to the definition used and the population analyzed, being higher in ICU inpatients and in those with increased initial caloric supply. According to these guidelines, patients at the highest risk for refeeding syndrome meet one or more of the following criteria: Body mass index (BMI) under 16; Weight loss of more than 15 percent of his or her body weight in the past 3 to 6 months; Little to no food for the past 10 or more consecutive days; or J Eat Disord. WebRefeeding Syndrome NICE guidance (CG32) recommends that for people identified as being at high risk of developing refeeding syndrome, the following should be provided immediately before and during the first 10 days of reintroducing feeding only: oral thiamine 200-300 mg daily vitamin B compound strong 1 or 2 tablets, three times a Nutr Clin Pract. Four databases were systematically searched until September 2020 for retrieving trials and observational studies. Effect sizes were expressed as 95% confidence intervals (CIs) and calculated using random-effects models. A history of alcoholism or misuse of certain drugs, such as insulin, chemotherapy drugs, diuretics or antacids. 2014;71(2):1007. You have a history of alcohol use disorder or use of certain medications, such as insulin, chemotherapy drugs, diuretics, or antacids. Additionally, the combination of plasma butyric acid levels and HIF3A intron 1 methylation at CpG 6 discriminated DCM patients from type2 diabetes mellitus (T2DM) patients. See additional information. 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? Long-term effects of enteral feeding on growth and mental health in adolescents with anorexia nervosa--results of a retrospective German cohort study. We use cookies to help provide and enhance our service and tailor content and ads. Perhaps carbohydrates should initially be limited to <40% of the total energy intake. Nehring and colleagues [37] concluded that NG feeding had no impact on growth, recovery or development of psychiatric co-morbidities. 1, 2 Its principles regard the family as the best treatment resource for recovery, hospitalization as a temporary solution, and Early RFH occurred in 40 patients (3%) in total, significantly more in the early-PN group (n=31, within-group occurrence 5%) than in the late-PN-group (n=9, within-group occurrence 1%, p<0.001). See, treatment of established refeeding syndrome, Treatment of established refeeding syndrome, https://traffic.libsyn.com/secure/ibccpodcast/IBCC_EP_83_-_Refeeding_Syndrome.mp3. Similar to the review conducted by Hale and Logomarsino [33] who found RS to be a rare complication, it is reassuring to find that no study in this review reported YP developing RS despite some studies starting on high calorie NG feeding plans [9, 18, 24, 42]. 2005;13(4):26472. The Charlson Comorbidity Index, however, was superior for preoperative risk stratification. Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, Kohn MR, et al. National Library of Medicine Agostino et al [23] compared a higher calorie (1500-1800kcal/d) continuous NG fed cohort to lower calorie oral bolus cohort (1000-1200kcal/d, divided 6 times per day), results showed mean weight gain was greater in the continuous NG fed group (1.22 kgs per week) than the oral bolus fed group (0.08 kgs per week) over the first 2weeks. To date, there is still no consensus regarding the RFS definition, and its incidence is therefore difficult to obtain. The most common symptoms are as follows: Unfortunately, there is no uniform definition of refeeding syndrome. The refeeding syndrome (RFS) is described as a set of metabolic and electrolyte alterations occurring as the result of the reintroduction of calories through oral, enteral, parenteral nutrition after a period of consistent reduction of energy intake or starvation in individuals with pre-existent malnutrition and/or in a catabolic state [[1], [2], [3]]. Kwashiorkor and marasmus are forms of undernutrition. A total of 4679 records were identified in the initial literature search. 1Southampton University Hospital NHS Trust, Southampton SO16 6YD, 2Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW. This is unknown. There were no studies from Asia, South America or Africa. Therefore, a universally accepted definition for RFS, taking different clinical contexts and groups of patients into account, is still needed to better characterize the syndrome and its approach.
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