A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. One study reported on weight gain where NG is routinely started on all ED YP regardless of context [23]. Nutr Dietetics. 2019. NG was also implemented due to acute refusal of food or inability to meet oral intake, without significant medical instability, in five studies [9, 10, 18, 31, 43]. Sodium (salt) replacement may also be carefully monitored. https://doi.org/10.12968/bjmh.2019.8.3.124. However, treatment providers should regularly monitor at-risk patients for symptoms of refeeding syndrome. 69.) 2009;18(2):7584. Advance diet gradually as tolerated. In addition, refeeding often occurs alongside other serious conditions that typically require simultaneous treatment. Provided by the Springer Nature SharedIt content-sharing initiative. Patients who were older (OR 1.14 (95% CI 1.08; 1.21) per year added, p<0.001) and who had a higher Pediatric Risk of Mortality (PIM3) score had a higher risk of developing early RFH (OR 1.36 (95% CI 1.15; 1.59) per unit added, p<0.001), whereas patients in the late-PN group had a lower risk of early RFH (OR 0.24 (95% CI 0.10; 0.49), p<0.001). Permissive hyperglycemia could be safer than the administration of high doses of insulin. Refeeding syndrome. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidan Nocturnal nasogastric refeeding for hospitalized adolescent boys with anorexia nervosa. During replenishment, the supply of nutrients, above all carbohydrates, results in enhanced insulin secretion, stimulating both glycolysis, the synthesis of glycogen, fats, proteins and increased sodium and water retention [5]. In 13 studies (3 high risk of bias [28, 35, 47]) in which NG was not implemented as standard protocol for all patients, the percentage of ED YP administered NG feeding in all contexts (due to medical instability or inadequate oral diet) varied between 6 and 66% [9, 18, 29, 31, 36, 37, 41,42,43,44]. Shifts in electrolyte levels can cause serious complications, including seizures, heart failure, and comas. To examine the impact of nutritional intake on phosphate concentrations, structural nested mean models with propensity score and censoring models were used. Overall, this review found 5 studies [9, 18, 23, 24, 29] reported some incidence of electrolyte disturbance, 2 studies [29, 39] described epistaxis and 1 study [39] described behavioural problems associated with the procedure. Until recently, refeeding syndrome (RFS) has lacked standardized diagnostic criteria. Refeeding Syndrome: Prevention and Management Sydney Childrens Hospital Practice, Guideline June 2013 Crook MA. There is a low risk of complications associated with NG feeding if staff receive adequate training and protocols are enforced to ensure that the tube has been passed correctly [11]. Two main criteria for RFS diagnosis were proposed: 1) a decreasing from 10% upwards of serum phosphorus, potassium, and/or magnesium concentrations and/or the presence of organ dysfunction resulting from a reduction in any of these and/or due to thiamin deficiency; and 2) the occurrence of these impairments within 5 days of reinitiating or substantially increasing energy supplies [1,12]. Higher caloric refeeding is safe in hospitalised adolescent patients with restrictive eating disorders. Other metabolic changes can also occur. Conversely, Akgul and colleagues [36] described a much shorter average time, 2.5days, that YP required NG before transitioning to an oral diet. For nocturnal feeds, oral diet was encouraged during the day. 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], The subjects at risk of developing RFS are characterized by reduced insulin secretion and increased glucagon release, with a metabolic shift towards the utilization as energy sources of proteins and fats instead of glucose with resulting muscle mass loss, and a decrease in intracellular vitamins and minerals, particularly phosphate, potassium, and magnesium, due to undernutrition [4]. Strik Lievers L, Curt F, Wallier J, Perdereau F, Rein Z, Jeammet P, et al. https://doi.org/10.1186/s40337-021-00445-1, DOI: https://doi.org/10.1186/s40337-021-00445-1. Retrospective cohort analysis of 5 glycaemic control cohorts spanning 4 years (n=273) from Christchurch Hospital Intensive Care Unit (ICU). A systematic review of enteral feeding by nasogastric tube in young people with eating disorders. The findings of this systematic review suggested that specific subgroups of population, such as inpatients from ICU and those initially supplied with higher caloric intakes, might have an increased risk for RFS/RH, but robust evidence is still lacking. Birmingham CL, Su J, Hlynsky JA, Goldberg EM, GAO M. The mortality rate from anorexia nervosa. Treatment of patients with eating disorders. Refeeding with a lower calorie provision and a slow energy increase may be a better approach for severely malnourished patients with chronic comorbidity, while higher caloric intakes might be reserved for moderately malnourished patients with acute illnesses [ 69 ]. Gusella and colleagues [41] compared parent led therapy (PLT) to non-specific therapy (psychologist led talking therapy). If youre recovering from an eating disorder or wanting a more positive relationship to food, these apps can. A survey of dietitians found 82% considered NG feeding a necessary procedure if oral diet is inadequate [10]. 3708-3717, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. However, this new definition may be insufficiently specific for clinically relevent electrolyte changes and requires clinical validation. By continuing you agree to the use of cookies. The search criteria was peer reviewed by a researcher from the University of Yorks Child and Adolescent Mental Health Intervention Centre. Turk J Pediatr. https://doi.org/10.1136/bmjopen-2018-027339. Adolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment. Most patients (96%) however present less severely with serum hypophosphataemia and no clinical signs [19]. Web[34][35][36] Multiple studies apply or recommend the classification of refeeding risk according to the NICE criteria. 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]. Outcomes of an inpatient refeeding protocol in youth with anorexia nervosa: Rady Childrens hospital San Diego/University of California, san Diego. No substantial change in the originally reported incidence of RFS was found by applying the ASPEN criteria. Significant discrepancy (>700 calories) was noted between nurse-estimated caloric intake compared to digital images. Refeeding syndrome: Is a less conservative approach to refeeding safe? FOIA Nehring I, Kewitz K, Von Kries R, Thyen U. Moreover, refeeding syndrome is seems to be associated with increased 6 months mortality [15]. This leads to another condition called hypophosphatemia (low phosphate). The evolution of all aspects of HPN is presented. Recent guidance from the British Dietetic Association [14] for NG feeding under restraint advised 12 bolus feeds per day even in those with high risk of refeeding syndrome (RS); it also concluded further research into this area was required. When NG feeding is used under restraint bolus feeds are preferred due to concerns around the tube being removed by the YP once restraint had ceased [45]. Best C. How to set up and administer an enteral feed via a nasogastric tube. To diagnose RFH most studies have used the occurrence of hypophosphatemia or a drop in serum/plasma phosphate after reintroduction of nutrition [11]. The site is secure. 2019;115(12):501. https://doi.org/10.1093/pch/pxx063. Prior to 2017, St Georges Hospitals refeeding guidelines (Figure 2/Figure 3) were not in line with NICE's Nutrition Support for Adults guidelines (CG32). This audit included patients from January November 2017 whereby 51 patients were identified as high risk or extremely high risk and 3 were classed as at risk. Check electrolytes (including magnesium and phosphate), with aggressive repletion as needed. 2 studies [21, 47] examined male only cohorts but both were high risk of bias. Part of WebThiamine Supplementation in Treatment of Refeeding Syndrome 39 for refeeding syndrome, 100 mg of thiamine is METHODS recommended before initiating feeding or IV uids and 100 mg/day for 5 to 7 days or longer Given the paucity of data on thiamine in patients with severe starvation, chronic supplementation and refeeding syndrome, a The .gov means its official. 2013;39(2):8593. Roux H, Chapelon E, Godart N. Epidemiology of anorexia nervosa: a review. 2015;45(2):41527. Refeeding syndrome is a serious and potentially fatal complication of nutritional rehabilitation in patients with severe anorexia nervosa. Young people with eating disorders often restrict food intake to a degree which is detrimental to their physical health. Front Psychol. Background The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. A team with experience in gastroenterology and dietetics should oversee treatment. Further research is required to assess which method is the safest, most efficacious and best aids transition back to a fully oral diet. Conversely any hospital admission was significantly longer (P<0.0001) for a YP requiring NG feeding compared to those managing an oral diet in a German retrospective cohort study [37]. The inclusion criteria were: NG feeding, participants under 18years, eating disorders, published since 2000 and primary research. There was a wide variety in length of time receiving NG for medical instability. Together, these processes can lead to decreased concentrations of minerals in the blood, of which hypophosphatemia is the most characteristic [14]. You have a history of alcohol use disorder or use of certain medications, such as insulin, chemotherapy drugs, diuretics, or antacids. A retrospective design also creates selection bias as those lost to follow up are not considered. Refeeding syndrome is caused by sudden shifts in the electrolytes that help your body metabolize food. Neiderman M, Farley A, Richardson J, Lask B. Nasogastric feeding in children and adolescents with eating disorders: toward good practice. Bayes A, Madden S. Early onset eating disorders in male adolescents: a series of 10 inpatients. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The reintroduction of enteral or parenteral nutrition, leading to refeeding hypophosphatemia (RFH), has been presented as potential risk factor. The risk for developing refeeding syndrome correlates directly with the extent of weight loss that accompanies anorexia nervosa.
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