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. 2017 Jul 26;1(1):e000022.
doi: 10.1136/bmjpo-2017-000022. eCollection 2017.

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

Beth Hazeldine  1 , Balamurugan Thyagarajan  1   2 , Michellee Grant  1 , Elavazhagan Chakkarapani  1   2
Affiliations

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

Beth Hazeldine et al. BMJ Paediatr Open. .

Abstract

Objective: To evaluate current nutritional practices during and after therapeutic hypothermia (TH) for infants with hypoxic-ischaemic encephalopathy (HIE) in UK neonatal units.

Study design: Email survey of neonatal clinicians.

Setting: UK neonatal units providing active TH.

Patients: Neonates cooled for HIE.

Methods: Email survey including questions regarding the timing of starting enteral feeds, volumes, frequency and parenteral nutrition (PN) use and availability of guidelines.

Results: Forty-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.

Conclusions: Many 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.

Keywords: breast milk; enteral feeding; nutrition; perinatal asphyxia; therapeutic hypothermia.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Comparison of rates of enteral feeding between 2014 and 2016, with day of commencement of enteral feeds for 2016 data. TH, therapeutic hypothermia.
Figure 2
Figure 2
Types of nutrition offered by units during therapeutic hypothermia and rewarming. Clear fluids represent glucose or sodium chloride infusions either as drug infusions or for maintaining hydration. NBM represents no enteral feeding given or nil by mouth. DBM, donor breast milk; EBM, expressed breast milk; NBM, nil by mouth; PN, parenteral nutrition.
Figure 3
Figure 3
(A)Percentage of units offering different types of nutrition by day during and post-TH, in addition to clear fluids/infusions. Once on enteral feeds, use of PN is not displayed for clarity. Enteral feeds may be only ‘trophic feeds’. (B) Frequency of enteral feeds given by units by day of treatment. DBM, donor breast milk; EBM, expressed breast milk; NBM, nil by mouth; PN, parenteral nutrition; RW, rewarming; TH, therapeutic hypothermia.
See this image and copyright information in PMC

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