Refeeding Syndrome in Pediatric Age, An Unknown Disease: A Narrative Review

One Page in the History of Starvation and Refeeding

There is a long history of starvation, including reports dated back to antiquity. Despite exceptional scientific developments, starvation still exists today. The medical aspects of starvation were well established in the twentieth century, particularly following studies related to the 1943-1944 Bengal famine in India and starved prisoners of war and survivors of World War 2. The refeeding of the starved victims provided disappointing results. Nevertheless, those studies eventually led to the development of a new branch of research in medicine and to the definition of what is now known as refeeding syndrome. This paper briefly reviews the history and groundwork that led to today's understanding of starvation and refeeding, with a particular emphasis on the observations from studies on starved Holocaust survivors and prisoners of war after World War 2. The relevance of these studies for modern times is briefly discussed.

Adherence to Dutch Guideline in Hospitalized Anorexia Nervosa Adolescents

Background. The Dutch guideline Eating Disorders defines admission criteria for children with anorexia nervosa (AN) in need for medical stabilization and advices close monitoring to detect refeeding syndrome (RFS) in an early stage. Methods. Admission criteria, recommendations at admission, and during first week of hospitalization were evaluated in accordance to the guideline. RFS was defined as decreased electrolyte concentrations and/or clinical features. Results. 22 patients were included with a total of 50 admissions. We observed that 62% of the admitted patients met one of the admission criteria, 190/300 (63%) recommended admission examinations were performed. During admission adherence decreased, in particular daily weighing and physical examination (12% and 6%, respectively). The guideline was not fully followed in any of the patients. None of the hospitalized patients met the RFS criteria. Conclusion. Guideline adherence was moderate and can be improved by a few adaptations, which may limit unnecessary laboratory testing.