Presented at the Neonatal Society 2013 Spring Meeting.
Thyagarajan B1, Tillqvist E2, Hallberg B2, Vollmer B2,3, Blennow M2, Baral V1
1 Neonatal Medicine, Princess Anne Hospital, Southampton, UK
2 Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
3 Clinical and Experimental Sciences, University of Southampton, Southampton, UK
Background: Delayed introduction of enteral feeding during therapeutic hypothermia is common practice in many UK neonatal units1 while Swedish neonatal units encourage early enteral feeding. There are no randomised trials supporting either practice in paediatric or adult population. We compared the safety and efficacy of early versus delayed enteral feeding in neonates receiving therapeutic hypothermia following hypoxic ischemic encephalopathy. Ethical approval was obtained in Sweden and in the UK for this study.
Methods: Retrospective cohort study (January 2009 – December 2011). Cooled infants at Karolinska Hospital, Stockholm (KH) received early enteral feeding (study group) and were compared to similar infants at Princess Anne Hospital (PAH) Southampton, who had delayed feeding (control group). Infants also received early parenteral nutrition in both centres. Statistical analysis (Kaplan-Meier curves, the Log Rank test and chi square tests) were done in SPSS.
Results: A complete data set was available for 34/37 infants at PAH compared to 51/51 at KH. Mean baseline parameters at PAH/KH were gestation at birth (39+3/ 40+1 weeks+days), birth weight (3420/3723 g), male sex (47.1%/54.9 %), umbilical arterial pH (7.02/7.05) and base deficit (-14.5/-12.03). There were significant differences between PAH/KH in enteral feeding rates (33.3/91.7%), mean time to initiation of enteral feeds (86.7/28.7 hours) and mean daily volume of enteral feeds during hypothermia.
There was no significant difference between the groups in time to achieve full enteral feeding (figure 1). The KH cohort reached full oral feeding and were discharged home significantly later than the PAH cohort (figure 2,3). There were no significant differences between the two groups regarding adverse events necrotising enterocolitis, clinically confirmed sepsis or persistent pulmonary hypertension.
Conclusion: Early enteral feeding during hypothermia appears to be safe and not associated with additional morbidity. Delayed introduction of enteral feeds does not delay the time to reach full oral feeds or prolong the length of stay at hospital. Further prospective randomized controlled trials are needed to verify these findings and to see if early enteral feeding during therapeutic hypothermia leads to improved outcomes.
Corresponding author: tbmgn@yahoo.co.uk
References
1. Azzopardi D, Strohm B, Edwards AD, et al. Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is managed in the UK outside a clinical trial. Arch Dis Child Fetal Neonatal Ed 2009;94:F260-4