Title of Cases:
Infant with failure to thrive 2nd to poor calorie intake and risk of Refeeding Syndrome
Background:
Infant in prolonged periods of inadequate nutrition has high risk of refeeding syndrome. Therefore, energy and protein given need to increase day by day and need close monitoring.
Client History:
Baby AI who is a 2 months 8 days Malay full term baby girl. She currently being diagnosed with failure to thrive (FTT) 2nd to poor calorie intake. She had been electively admitted from clinic to Hospital Kajang. She was the 1st child in the family.
Assessment (Anthropometry & Food Nutrition History):
The baby’s weight, length, head of circumference and weight-for-length were under 5th percentile. Her birth weight was 2.31 kg and current weight was 2.56 kg. It shows that this baby was in phase of poor weight gain. (CDC growth chart)
Feeding history: BFOD maximum 1 oz/day and MCT oil 3x/day. Due to this, Dr had planned to watch out for refeeding syndrome in view of patient in prolonged periods of inadequate nutrition.
Currently: Patient had been given with BFOD 12x/day but maximum was still same. Fortunately, mother had just started on Formula milk with ratio of 1:1 of Lactogen 1 and H2O
Nutrition Diagnosis:
Breastfeeding difficulty and Inadequate oral intake related to Maternal difficulties (low production of breastmilk) as evidenced by Poor weight gain, patient crying after breastfeeding, low energy and protein intake and breast milk production 1oz maximum.
Objective of management & Nutrition prescription:
Objective: To avoid refeeding syndrome. The energy and protein given to the patient will be increased day by day according to two guidelines.
Planned: Monitor on frequency of BFOD and formula milk given.
The energy prescribed was 384 – 512 kcal/day, protein with 7.68 g/day and fluid 384 ml/day.
Outcome / follow-up:
During 1st, 2nd and 3rd f/up, it shows that appetite had increased. Latest weight was 2.66 kg with weight gain 50 g/day exceed recommendation. Latest electrolyte result showed that patient does not have refeeding syndrome. Energy intake was 75 kcal/kg BW with protein 1.1 g/kg BW. Feeding was well tolerated and frequency had increased.
Discussion:
Target to start feeding at 50% from requirement and gradually increases the feeding within 1 – 3 days and increased feeding at day 4 if electrolyte normal. (ASPEN and Capetown guideline)
Learning points/ Take home message:
- Handling Refeeding syndrome on paediatric patient was different compared to adult patient.
- Mother plays important role in providing adequate energy and protein to the baby
- Need to educate mother on lactation procedure and healthy food intake during lactation besides overcome baby’s current condition.
