PC.78 How do we and how should we optimise nutrition during therapeutic hypothermia?

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Abstract

Background

There has been a lot of interest in therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy (HIE), and increasingly, neonates suffering ischaemic insult receive TH. However, we have yet to elucidate the best feeding regime. There is some data for adult TH but limited work has been done in neonates.

Aim

To assess current feeding practice in neonates undergoing TH for HIE.

Methods

25 neonates who received TH at Addenbrooke’s hospital in 2012 were identified from the TOBY trial register. Baseline demographics, details of clinical condition and feeding protocols were recorded.

Results

The age at starting enteral feeds had a wide range (2–7 days) but most reached full feeds by 6–10 days. Three suffered gastrointestinal complications and reached full feeds later (initially day 7, 11, 28, maintained by day 17, 21, 28 respectively). Metabolic markers were not correlated with day enteral feeds started. HIE grade was related to feeding practice (see table).

Conclusions

Despite concerns about optimising nutrition in HIE, most reached full feeds by day 10 suggesting little detrimental effect from the delay in enteral feeds. Identifying those at risk of developing GI complications remains important. However, the data did not reveal any obvious objective markers (metabolic markers or HIE grade) for risk.

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