Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Transient hyperinsulinemia may be responsible from electrolyte abnormalities of refeeding syndrome seen in very low birth weight infants with intrauterine growth-restriction

Journal of Perinatology volume 34, page 247 (2014)Cite this article

Subjects

We read with great interest the article by Ross et al.,1 in which they report the incidence of refeeding syndrome, defined by the presence of hypophosphatemia, in very low birth weight (VLBW) infants with intrauterine growth restriction (IUGR) born to mothers with preeclampsia. They reported high incidence of refeeding syndrome and suggested that its occurrence, in addition to associated hypokalemia, hypomagnesemia and hyperglycemia, in IUGR VLBW infants is consistent with refeeding syndrome. However, IUGR infants are prone to hyperinsulinemic state,2, 3 and insulin transfers extracellular electrolytes into the intracellular compartment, as a consequence of which, increased transfer of phosphate from the extracellular into the intracellular compartment causes hypophosphatemia.4 Simmons et al.3 reported that newborn rats with IUGR caused by uterine placenta insufficiency developed mild fasting hyperglycemia, hyperinsulinemia and high insulin resistance index. Therefore, we think that electrolyte abnormalities (for example, hypophosphatemia, hypokalemia and hypomagnesemia) seen in refeeding syndrome of VLBW infants with IUGR may be due to transient hyperinsulinemia.

In addition, during aggressive parenteral nutrition, glucose supply stimulates endogenous insulin secretion, and hyperinsulinism leads to transfer of glucose and phosphate into cells. The combined effects of nutritional factors and increased insulin-mediated transport of phosphate with glucose from the extracellular to the intracellular compartment during refeeding can lead to drop in blood phosphate concentration.4, 5

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Ross JR, Finch C, Ebeling M, Taylor SN . Refeeding syndrome in very-low-birth-weight intrauterine growth-restricted neonates. J Perinatol 2013; 33: 717–720.

    Article  CAS  Google Scholar 

  2. Pezzati M, Barni S, Chiti G, Danesi G, Rubaltelli FF . Prolonged hyperinsulinemic hypoglycemia in a small for date preterm. Minerva Pediatr 2003; 55: 79–82.

    CAS  PubMed  Google Scholar 

  3. Simmons RA, Templeton LJ, Gertz SJ . Intrauterine growth retardation leads to the development of type 2 diabetes in the rat. Diabetes 2001; 50: 2279–2286.

    Article  CAS  Google Scholar 

  4. Boateng AA, Sriram K, Meguid MM, Crook M . Refeeding syndrome: treatment considerations based on collective analysis of literature case reports. Nutrition 2010; 26: 156–167.

    Article  Google Scholar 

  5. Marik PE, Bedigian MK . Refeeding hypophosphatemia in critically ill patients in an intensive care unit. A prospective study. Arch Surg 1996; 131: 1043–1047.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neonatology, Erzurum Training and Research Hospital, Erzurum, Turkey

    N Hakan

  2. Department of Neonatology, Elazig Training and Research Hospital, Elazig, Turkey

    M Aydin

  3. Department of Neonatology, Dr. Sami Ulus Maternity and Children's Hospital, Ankara, Turkey

    D Dilli, A Zenciroglu & N Okumus

Authors
  1. N Hakan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D Dilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Zenciroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N Okumus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Aydin.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hakan, N., Aydin, M., Dilli, D. et al. Transient hyperinsulinemia may be responsible from electrolyte abnormalities of refeeding syndrome seen in very low birth weight infants with intrauterine growth-restriction. J Perinatol 34, 247 (2014). https://doi.org/10.1038/jp.2013.181

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.181

This article is cited by

Search

Advanced search

Quick links