Minimal enteral nutrition during neonatal hypothermia treatment for perinatal hypoxic-ischaemic encephalopathy is safe and feasible

Thyagarajan, Balamurugan; Tillqvist, Emma; Baral, Vijay; Hallberg, Boubou; Vollmer, Brigitte; Blennow, Mats

doi:10.1111/apa.12838

Cited by 39 publications

(47 citation statements)

References 23 publications

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“…A study of patients with HIE in the UK and Sweden demonstrated that enteral feeding during hypothermia was not associated with increased mortality or morbidity [17]. The authors suggested that the greater number of patients that received human milk (fully breastfed or breastfed and bottle-fed) at discharge in Sweden (85%) versus the UK (67%) may have contributed to the results, but this difference was not statistically significant ( p = 0.08).…”

Section: Discussionmentioning

confidence: 99%

“…A cohort study on HIE patients, that received delayed enteral feeding in the UK and early enteral feeding during hypothermia in Sweden, demonstrated that enteral feeding during hypothermia was not associated with increased mortality or morbidity [17]. These results suggest that early minimal enteral nutrition (MEN) during hypothermia is feasible and is not associated with significant complications.…”

Section: Introductionmentioning

confidence: 99%

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Enteral Feeding as an Adjunct to Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy

et al. 2018

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Background: Withholding enteral feedings during hypothermia lacks supporting evidence. Objectives: We aimed to determine if minimal enteral nutrition (MEN) during hypothermia in patients with hypoxic-ischemic encephalopathy was associated with a reduced duration of parenteral nutrition, time to full oral feeds, and length of stay, but would not be associated with increased systemic inflammation or feeding complications. Methods: We performed a pilot, retrospective, matched case-control study within the Florida Neonatal Neurologic Network from December 2012 to May 2016 of patients who received MEN during hypothermia (n = 17) versus those who were not fed (n = 17). Length of stay, feeding-related outcomes, and brain injury identified by MRI were compared. Serum inflammatory mediators were measured at 0–6, 24, and 96 h of life by multiplex assay. MRI were scored using the Barkovich system. Results: MEN subjects had a reduced length of hospital stay (mean 15 ± 11 vs. 24 ± 19 days, p < 0.05), days receiving parenteral nutrition (7 ± 2 vs. 11 ± 6, p < 0.05), and time to full oral feeds (8 ± 5 vs. 18 ± 18, p < 0.05). MEN was associated with a significantly reduced serum IL-12p70 at 24 and 96 h (p < 0.05). Brain MRI scores were not significantly different between groups. Conclusion: MEN during hypothermia was associated with a reduced length of stay and time to full feeds, but did not increase feeding complications or systemic inflammation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enteral Feeding as an Adjunct to Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy

et al. 2018

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“…Despite adverse gut effects previously noted with HIE, moderate hypothermia has been shown to be gut-protective following ischaemia-reperfusion, 21 22 with a beneficial effect of TH on feed tolerance in neonates. 23 These reports combined with increasing experience in the use of TH, low rates of gut complications in cooled infants (0.7%) 7 and reports suggesting the safety of minimal enteral feeds during TH 18 may have increased confidence in starting enteral feeds during TH. Clinicians were starting feeds particularly in infants with moderate HIE, with no other signs of compromise (ie, need for inotropic support).…”

Section: Discussionmentioning

confidence: 99%

“…16 A survey presented in 2014 reported that 21% of UK neonatal units offered trophic feeds during TH, but lacked data on when milk was introduced, milk type, volumes, frequency and advancement of feeds. 17 Given reports of the safety of small-volume enteral feeds during TH, 18 we hypothesised that rates of enteral feeding would have increased. In this study, we aimed to survey clinicians in UK neonatal units providing active TH for determining current nutritional practices during and after TH in infants with HIE.…”

Section: Introductionmentioning

confidence: 99%

Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy

Hazeldine

Thyagarajan

Grant

et al. 2017

bmjpo

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ObjectiveTo evaluate current nutritional practices during and after therapeutic hypothermia (TH) for infants with hypoxic-ischaemic encephalopathy (HIE) in UK neonatal units.Study designEmail survey of neonatal clinicians.SettingUK neonatal units providing active TH.PatientsNeonates cooled for HIE.MethodsEmail survey including questions regarding the timing of starting enteral feeds, volumes, frequency and parenteral nutrition (PN) use and availability of guidelines.ResultsForty-nine responses were received (49/69, 71%). The rate of enteral feeding during TH and rewarming was 59% (29/49). There was a significant linear trend for the increase in the proportion of units starting enteral feeds (p=0.001) during TH. As compared with post-TH period, significantly lower milk volumes were started during TH (median (range): 7.5 mL/kg/day (1.5–24) vs 17.5 mL/kg/day (7.5–30), p=0.0004). During TH, breast milk was primarily used by 52% of units predominantly as 2–3 hourly feeds, and volumes were increased as tolerated in 55% of units. Only 29% (14/49) of units used PN, with 86% (12/14) of those offering enteral feeds during PN. Guidelines for feeding during TH were available in 31% (15/49) of units.ConclusionsMany neonatal clinicians offer enteral feeds predominantly using expressed breast milk, with or without PN, during TH, although with huge variability. The heterogeneity in the nutritional practice underscores the need for assessing the safety of both enteral and parenteral feeding during TH.

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“…22 The Scandinavian protocols and some authors from the USA allow minimal enteral feeding throughout the hypothermia period, and they show reduced time to full feeds and shorter hospital stay without increased risk of complications. 23,24 We also found a significant change in the systemic hemodynamic parameters after rewarming such as increase in the HR, systolic BP and LVO with no significant difference in the LVEF over the various time points during hypothermia and after rewarming. These findings are consistent with other hemodynamic studies on infants with HIE undergoing therapeutic hypothermia that have focused on cardiac and cerebrovascular hemodynamics.…”

Section: Discussionmentioning

confidence: 53%

Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy

Sakhuja

Ting

et al. 2019

Pediatrics & Neonatology

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Background: Hypoxic-ischemic encephalopathy (HIE) is associated with disturbances in visceral blood flow velocities. Therapeutic Hypothermia (TH) is a standard of care; however, its impact on gastrointestinal blood flow in infants with HIE is unknown. The objective of this study was to assess gastrointestinal (GI) blood flow and left ventricle output (LVO) in infants with hypoxicischemic encephalopathy during whole body TH and after rewarming. Methods: Serial echocardiography and Doppler evaluation of intestinal blood flow (celiac (CA) and superior mesenteric (SMA) arteries) were prospectively performed in a cohort of 20 newborn infants with HIE at 4 time points during hypothermia and after rewarming. Demographic, clinical and biochemical data were collected and analyzed for their relevance. Results: Median gestational age and birth weight was 40 weeks (37e41) and 3410 g (2190 e4950) respectively. Celiac and mesenteric artery flow remained low during hypothermia and rose significantly after rewarming [peak systolic velocity in CA (0.63 m/s to 0.77 m/s, p Z 0.004) and SMA (0.43 m/s to 0.55 m/s, p Z 0.001)]. This increase was temporally associated with increased left ventricular output (106 ml/kg/min to 149 ml/kg/min, p < 0.0001).

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Minimal enteral nutrition during neonatal hypothermia treatment for perinatal hypoxic-ischaemic encephalopathy is safe and feasible

Abstract: Early minimal enteral feeding during hypothermia proved feasible, with no significant complications. Delayed enteral feeding did not affect time to full enteral feeding.

Cited by 39 publications

References 23 publications

Enteral Feeding as an Adjunct to Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy

Enteral Feeding as an Adjunct to Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy

Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy

Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy

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