The identification and management of refeeding syndrome in inpatient severely acutely malnourished children aged 6 to 59 months

ABSTRACT

¹Mogase T,
²Van Onselen A ,
³Galloway S ,
⁴Rodriguez-Sanchez N

¹Human Nutrition and Dietetics, Health Science, SMU, University of Stirling, Scotland, UK
²Department of Life and Consumer Sciences, University of South Africa
³Faculty of Health Sciences and Sport University of Stirling
⁴Faculty of Health Sciences and Sport University of Stirling

Background

Background: Refeeding syndrome is a potentially fatal complication that occurs in inpatient, severely acutely malnourished children during the early phase of nutritional management. Its early identification and management are critical to preventing adverse outcomes. Addressing refeeding syndrome in inpatient settings is critical in Sub-Saharan Africa, where severe acute malnutrition is common and under-researched.
Objective: This systematic review aims to evaluate the current evidence on the identification and management of refeeding syndrome in inpatient severely acutely malnourished children aged 6 to 59 months in Sub-Saharan African countries.

Method

A comprehensive search was conducted across academic databases such as PubMed and the Cochrane Library, from 2010 to 2024. Articles reporting on the identification and management of refeeding syndrome in inpatient children with severe acute malnutrition in Sub-Saharan Africa were included. Rayyan software of systematic review was used for data extraction and synthesis, which were conducted using predefined criteria.

Result

This review includes nine studies in total. Results show that the identification and management of refeeding syndrome in children with severe acute malnutrition has been greatly impacted by the lack of a standardised definition. The homogeneity test indicates a significant heterogeneity (Q = 27.17, p<.001), indicating a significant variation in the prevalence rates reported across the different studies, with reported rates ranging from 8.7% to 34.8%. Management strategies also varied; the majority of studies followed WHO recommendations for severe acute malnutrition but lacked refeeding syndrome-specific protocols.

Conclusion

The outcomes highlight the critical need for standardised, evidence-based protocols for the identification and management of refeeding syndrome in children with severe acute malnutrition who are admitted to hospitals. Reducing refeeding syndrome-related mortality and morbidity requires improving screening methods, raising healthcare provider awareness, and ensuring consistent electrolyte monitoring. Prospective studies should be the main focus of future research to develop efficient, specific management methods.

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PRESENTING AUTHOR

Ms. Tshegofatso Mogase, M.Sc. in Medical Science (Physiology) Sefako Makgatho Health Sciences University 2015 – 2018

Principal Technical Officer, Sefako Makgatho Health Sciences University and University of Stirling

Tshegofatso holds the following qualifications: Honors in Medical Science (Physiology) in 2014 at the University Of Limpopo (MEDUNSA campus) where the research focus area was cardiovascular physiology and pathophysiology. Moreover, holds a Master’s in Medical Science (Physiology) in 2018 at Sefako Makgatho Health Sciences University and the research area was lifestyle diseases. She is currently a Cotutelle PhD candidate of the UK-SA DHET Doctoral Training Program, registered in Nutrition and Dietetics (PhD) at Sefako Makgatho Health Sciences University and the University of Stirling in Scotland, UK with the Department of Nutrition and Dietetics and Faculty of Health Sciences and Sport, respectively. Moreover, she is part of the British Academy Research Career Development Programme and a recipient of the SAMRC Research Capacity Development Initiative grant. Her current research is in Paediatrics, where she focuses on the assessment of Refeeding Syndrome in severely acute malnourished children aged 6 to 59 months. Furthermore, she gained a certificate for Enhancing Academic Qualifications in Teaching and Research in Public Health at Heidelberg University Hospital during the summer school in 2019, Germany.

She has over 5 years of experience in academia in Human Physiology as a principal technical officer with a keen interest in teaching and research. She has been actively involved in teaching across many levels of Human Physiology courses as well as in the postgraduate program, particularly as the course coordinator and lecturer for the honours level. With her research coordination and passion for teaching, she has designed a research course for the honours students that will enable them in transfer knowledge. She has a record of supervising postgraduate students, got the opportunity to do an oral presentation of her MSc research outcome during the Sefako Makgatho Health Sciences Research Day held in September 2018, and got the Best Postgraduate Student Paper-Third Place. Moreover, she did an Oral Presentation at the 11TH TSHWANE DISTRICT HEALTH SERVICES RESEARCH CONFERENCE on the 26 & 27th of September 2024 at Mamelodi Regional Hospital. The title of the presentation was “EXPLORING THE POTENTIAL USE OF BIOELECTRICAL IMPEDANCE VECTOR ANALYSIS IN ASSESSING SEVERE ACUTE MALNUTRITION IN HOSPITALISED CHILDREN UNDER 5 YEARS OF AGE IN SUB-SAHARAN AFRICAN COUNTRIES: A NARRATIVE REVIEW” and won an award for this oral presentation under the Maternal, Child, Women’s Health and Nutrition category. She is a wife, mother of a beautiful daughter and a pastor.

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