Infant Malnutrition (FTT) — Assess for Dehydration, Hypoglycemia, and Risk for Refeeding Syndrome — Clinical Pathway: Inpatient

Infant Malnutrition/Failure to Thrive (FTT) Clinical Pathway — Inpatient

Assess for Dehydration, Hypoglycemia, and Risk for Refeeding Syndrome

  Assessment If present/If at risk
Dehydration Follow Inpatient Clinical Pathway for Continuous Administration of IV Fluids
Hypoglycemia
  • Overly sleepy or hard to wake up
  • Jittery
    • < 4 weeks old with poor feeding
    • Newborns may display few or no symptoms
  • Check point of care blood glucose (D-Stick)
  • If hypoglycemic (< 70 mg per dL), feed and recheck within 30 minutes
Refeeding Syndrome

Refeeding syndrome can cause severe metabolic disturbances in malnourished patients, however is very uncommon among infants with malnutrition.
  • Significant weight loss, diarrhea, and/or emesis.

  • and at least one of the following:

  • Underfeeding > 7 days defined as intake of ≤ 50% of estimated needs
  • Deceleration of weight for length across 2 z-scores
  • Weight for length/height z-score < -2
    • Ensure accurate length measures used
  • If length z-score < -3:
    • Consider if stunting is related to poor intake versus other reasons (e.g., genetic syndrome, chronic medications, etc.)
  • Classic marasmus or kwashiorkor (edematous malnutrition)
  • Abnormal labs, including low levels of potassium, phosphorus, magnesium, decreased prealbumin prior to nutrition intervention
  • Consider daily BMP, magnesium, and phosphorus until goal feeds are reached, and replete as needed

  • Initiate feeds at 50-75% of goal intake and advance slowly by 10 - 15% daily to their goal

Newborn Screen

The newborn screen is used to detect a number of inborn errors of metabolism and cystic fibrosis, which can be causes of malnutrition.

How to access:

  • Check Media Tab in Epic if patient has CHOP Care Network PCP
  • Perkin Elmer  
  • Call NICU newborn screen nurse, #40332