Background There is widespread variation in enteral feeding practices of infants receiving therapeutic hypothermia (cooling) following hypoxic ischemic encephalopathy (HIE). We compared the safety and efficacy of early versus delayed enteral feeding during cooling.
Methods Retrospective case control study (January 2009 – December 2011). Cooled infants at Karolinska Hospital, Stockholm (KH) received early enteral feeding and were compared to similar infants at Princess Anne Hospital (PAH) Southampton, who had delayed feeding (controls). Infants also received early parenteral nutrition in both centres.
Results A complete data set was available for 28/37 infants at PAH compared to 51/51 neonates at KI. Mean baseline parameters at PAH/KH were birth weight (3404.80/3723 g), male/female ratio (50/55 %), umbilical arterial pH (7.1/7.04) and base deficit (–15.65/–12.03).
There were differences in enteral feeding rates at PAH/KH (20.1/91.0%). The mean volume of enteral feeds (mls/kg/day) at PAH/KH on days 1–4 were: 0/2.1, 0.2/6.1, 1.8/10.1, 1.9/17.1.
There were also differences (PAH/KH) in mean time to establishing full nasogastric tube feeding (5.9/7.2 days) achieving full oral feeds (7.45/10.1 days) and breast feeding rates at discharge (56/70.2%). The mean length of stay was 9.77/14.7 days (PAH/KH).
One baby developed spontaneous intestinal perforation at KH but none developed necrotising enterocolitis in either centres.
Conclusion Feeding practices during hypothermia varies between centres. Early enteral feeding during hypothermia is safe and not associated with any additional morbidity. However, delayed introduction of enteral feeds does not delay the time to reach full enteral feeds or prolong the length of stay at hospital.