Adequate nutrition during therapeutic cooling for ischaemic injury in the newborn is important in minimising long-term neurological morbidity.1
National TOBY guidelines suggest enteral feeds may be ‘cautiously introduced’ during cooling following the correction of biochemical and metabolic disturbances.2
However, it has been suggested that neonates exposed to hypoxic injury are at increased risk of developing necrotizing enterocolitis (NEC) and so feeds should be withheld until re-warming.3
A national survey was performed to gain insight into current approaches towards enteral feeding during therapeutic cooling.
Methods Hospitals were contacted by telephone and asked standardised questions about nutritional practice during cooling. 42 of the 47 units to provide cooling in the UK supplied information.
Results 67% of hospitals had no guidelines or had guidelines that failed to provide information with regards to starting enteral feeds during cooling.
79% do not give enteral nutrition during cooling. Of these, 24% of guidelines cited risk of NEC/GI complications as justification. 70% offered no reasoning for the recommendation.
In these units, 45% began patients on TPN (± lipids), while 55% provide only IV fluids.
No units give full enteral nutrition, however 21% of units provide trophic feeds, preferentially using expressed breast milk most frequently at a rate of 1 mL 1–4 hly, with supplemental IV fluids and no adjunctive TPN.
Conclusion This survey concludes that there is no uniform approach to nutrition during therapeutic cooling in neonates within the UK.
Further research and subsequent guideline development is essential to ensure optimal treatment is given to this patient group.
References 1 JY Ting, D Manhas, SM Innis, S Albersheim, Elevated Triglycerides Levels in Two Infants With Hypoxic-ischemic Encephalopathy Undergoing Therapeutic Hypothermia and Receiving Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2013 Jul 26, Epub ahead of print
2 The UK TOBY Cooling Register – Clinician’s Handbook Available: https://www.npeu.ox.ac.uk/tobyregister/docs Accessed: 07/04/2014
3 R Mosalli, Whole Body Cooling for Infants with Hypoxic-Ischemic Encephalopathy, J Clin Neonatol. 2012 Apr-Jun; 1(2): 101–106
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