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Hazeldine B, Thyagarajan B, Grant M, et al. Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy. BMJ Paediatr Open. 2017;1(1):e000022doi: 10.1136/bmjpo-2017-000022.
Hazeldine, B., Thyagarajan, B., Grant, M., & Chakkarapani, E. (2017). Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy. BMJ paediatrics open, 1(1), e000022. https://doi.org/10.1136/bmjpo-2017-000022
Hazeldine, Beth, et al. "Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy." BMJ paediatrics open vol. 1,1 (2017): e000022. doi: https://doi.org/10.1136/bmjpo-2017-000022
Hazeldine B, Thyagarajan B, Grant M, Chakkarapani E. Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy. BMJ Paediatr Open. 2017 Jul 26;1(1):e000022. doi: 10.1136/bmjpo-2017-000022. eCollection 2017. PMID: 29637095; PMCID: PMC5842999.
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BMJ Paediatr Open. 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.

BMJ paediatrics open

Beth Hazeldine, Balamurugan Thyagarajan, Michellee Grant, Elavazhagan Chakkarapani

Affiliations

  1. St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
  2. School of Clinical Sciences, University of Bristol, Bristol, UK.

PMID: 29637095 PMCID: PMC5842999 DOI: 10.1136/bmjpo-2017-000022

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

Conflict of interest statement

Competing interests: None declared.

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