The NICE guidelines for cooling in hypoxic ischaemic encephalopathy (HIE) have resulted in increasing numbers of babies being cooled. Optimising nutritional intake in intensive care is increasingly viewed as important, but there is limited guidance on risks verses benefits associated with either enteral or parenteral (PN) feeding routes.Aim
To determine current clinical practice across the UK regarding feeding in babies being cooled for HIE.Method
A telephone questionnaire to all units that are listed as cooling centres in the TOBY register (n = 67). One of 3 investigators spoke to either the nurse in charge or doctor (middle grade or above).Results
62 centres responded (93%). Clinical practice varied widely between centres, most having no specific feeding guidelines. 28 units (45%) did not feed during cooling, 25 (40%) said they would normally feed but dependent on clinical condition, and 9 reported using trophic feeds or occasionally feeding. Of those who would feed during cooling, the decision to feed was predominantly related to ventilator status, use of inotropes and/or lactate level. Most centres recommended EBM, 7 considering DBM if EBM was not available. Rate of milk increase varied widely. 34 units (55%) routinely started PN early while cooling, 9 rarely used PN, 4 used PN post cooling, 8 considered PN if there was significant delay in oral feeding, and 6 reported use to be very baby dependent.Conclusion
There is a wide range in current nutritional management of babies being cooled. Further work is needed to determine optimal management.