CASE REPORT article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1594715
This article is part of the Research TopicThe Impact of Micronutrients in the Intrauterine Environment on Offspring Development and MetabolismView all articles
A complicated case of neonatal refeeding syndrome following intrauterine growth restriction corrected by high dose thiamine supplementation
Provisionally accepted
- 1Department of Pediatrics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
- 2Department of Pediatrics, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Refeeding syndrome (RS), marked by severe electrolyte imbalances (e.g., hypophosphatemia, hypokalemia) and thiamine deficiency, poses significant risks during nutritional rehabilitation in intrauterine growth restriction (IUGR) neonates. This case report highlights the efficacy of high-dose thiamine (2 mg/kg IV) in resolving refractory RS in a preterm IUGR infant (34 weeks, 1415 g) unresponsive to standard electrolyte correction. Despite gradual caloric reintroduction and parenteral supplementation, the infant exhibited persistent hypophosphatemia (3.0 mmol/kg/day IV requirement), hypokalemia (4.3mmol/kg/day IV requirement), and thrombocytopenia (nadir 27×10⁹/L). Thiamine administration led to rapid clinical improvement within 4 hours, with electrolyte normalization (potassium: 2.19→4.41mmol/L; phosphorus: 0.69 → 2.35 mmol/L) and platelet recovery (27 → 112 × 10 ⁹ /L). The findings suggest thiamine deficiency may underlie refractory RS in IUGR neonates, advocating for early supplementation in high-risk cases. Further research is needed to optimize dosing and validate thiamine's role in RS management.
Keywords: Refeeding Syndrome, Electrolyte imbalance, Thiamine, intrauterine growth restriction, Casereport
Received: 16 Mar 2025; Accepted: 16 Jul 2025.
Copyright: © 2025 Wu, Li, Xu and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhongyue Li, Department of Pediatrics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
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