Accepted Article
Article Type : Regular Article
Minimal enteral nutrition during neonatal hypothermia treatment forperinatal hypoxic-ischaemic encephalopathy is safe and feasible Short title:Feeding duringhypothermia
Name of authors and affiliations: Balamurugan Thyagarajan* Neonatal Unit, Princess Anne Hospital, Coxford Road, Southampton, United Kingdom. Emma Tillqvist* Department of Neonatology & CLINTEC, Karolinska Hospital and KarolinskaInstitutet, Stockholm, Sweden. Vijay Baral Neonatal Unit, Princess Anne Hospital, Coxford Road, Southampton, United Kingdom, Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore. BoubouHallberg Department of Neonatology & CLINTEC, Karolinska Hospital and KarolinskaInstitutet, Stockholm, Sweden Brigitte Vollmer Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom Mats Blennow Department of Neonatology & CLINTEC, Karolinska Hospital and KarolinskaInstitutet, Stockholm, Sweden. *Balamurugan Thyagarajan and Emma Tillqvist have contributed equally and are joint first authors. Corresponding author: Balamurugan Thyagarajan* Address: Neonatal Unit, Princess Anne Hospital, Coxford Road, Southampton, United Kingdom. Email: [email protected] Telephone: +44-2380794643/6001
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/apa.12838 This article is protected by copyright. All rights reserved.
Accepted Article
Fax: +44-2380798522
Keywords Hypothermia, enteral nutrition, perinatal hypoxic-ischaemic encephalopathy, breastfeeding
Abstract Aim:The safety and efficacy of enteral feeding during hypothermia treatment following hypoxic ischaemic encephalopathy has not been studied before, resulting in variations in practice. Our study compared the benefits and safety of both early minimal and delayed enteral feeding during hypothermia treatment. Methods: Our retrospective cohort study,from January 2009 to December 2011, compared a Swedish cohort,who received early enteral feeding during hypothermia, and a UK cohort,who received delayed enteral feeding. Results:In Sweden (n=51), enteral feeds were initiated at a median of 23.6 hours and full oral feeding was achieved at ninedays (range 3-23). In the UK (n=34), the equivalent figures were 100 hoursand eight days (range 3-13) (p=0.01).Both groups achieved enteral feeding at a median six days. The median length of hospital stay was 13 days in Sweden and 10 days in the UK (p=0.04). More babies were fully breastfeeding or breast-fed and bottle-fed at discharge in Sweden (85%) than the UK (67%) (p=0.08). There were no significant differences between the two groups regarding adverse events. Conclusion: Early minimal enteral feeding during hypothermia provedfeasible,with no significant complications. Delayed enteral feeding did not affect time to full enteral feeding. KEY NOTES: •
The safety and efficacy of enteral feeding during hypothermia treatment following hypoxic ischaemic encephalopathy has not been studied before, resulting invariations in practice.
•
We compared 51 Swedish infants, who received early enteral feeding during hypothermia, and 34 UK infants, who received delayed enteral feeding.
This article is protected by copyright. All rights reserved.
Accepted Article This article is protected by copyright. All rights reserved.
Accepted Article
Patients and Methods The study was designed as a retrospective cohort study involving UK and Swedish cohorts from neonatal units that followed similar hypothermia protocols but had different feeding practices during HT treatment. The UK neonatal unit wasthe Princess Anne Hospital in Southamptonand the Swedish units were at the Karolinska Hospital Huddinge, Karolinska HospitalSolnaand Stockholm South General Hospital. All the units used the same protocols andpractices forhypothermia treatment. All infants undergoing HT at the participating neonatal units between 1 January 2009 and31 December 2011 were included in the study. The criteria for HT used by the centres are in accordance with the guidelines set by the Total Body Hypothermia for Neonatal Encephalopathycooling registry(8). Eligible infants were born at 36 weeks of gestation or more, had evidence of perinatal asphyxia and displayed clinical signs of moderate or severe encephalopathy according to Levene’s modification of the Sarnat and Sarnat classification(9). A diagnosis of perinatal asphyxia was made if one of the following criteria were met: APGAR
Article Type : Regular Article
Minimal enteral nutrition during neonatal hypothermia treatment forperinatal hypoxic-ischaemic encephalopathy is safe and feasible Short title:Feeding duringhypothermia
Name of authors and affiliations: Balamurugan Thyagarajan* Neonatal Unit, Princess Anne Hospital, Coxford Road, Southampton, United Kingdom. Emma Tillqvist* Department of Neonatology & CLINTEC, Karolinska Hospital and KarolinskaInstitutet, Stockholm, Sweden. Vijay Baral Neonatal Unit, Princess Anne Hospital, Coxford Road, Southampton, United Kingdom, Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore. BoubouHallberg Department of Neonatology & CLINTEC, Karolinska Hospital and KarolinskaInstitutet, Stockholm, Sweden Brigitte Vollmer Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom Mats Blennow Department of Neonatology & CLINTEC, Karolinska Hospital and KarolinskaInstitutet, Stockholm, Sweden. *Balamurugan Thyagarajan and Emma Tillqvist have contributed equally and are joint first authors. Corresponding author: Balamurugan Thyagarajan* Address: Neonatal Unit, Princess Anne Hospital, Coxford Road, Southampton, United Kingdom. Email: [email protected] Telephone: +44-2380794643/6001
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/apa.12838 This article is protected by copyright. All rights reserved.
Accepted Article
Fax: +44-2380798522
Keywords Hypothermia, enteral nutrition, perinatal hypoxic-ischaemic encephalopathy, breastfeeding
Abstract Aim:The safety and efficacy of enteral feeding during hypothermia treatment following hypoxic ischaemic encephalopathy has not been studied before, resulting in variations in practice. Our study compared the benefits and safety of both early minimal and delayed enteral feeding during hypothermia treatment. Methods: Our retrospective cohort study,from January 2009 to December 2011, compared a Swedish cohort,who received early enteral feeding during hypothermia, and a UK cohort,who received delayed enteral feeding. Results:In Sweden (n=51), enteral feeds were initiated at a median of 23.6 hours and full oral feeding was achieved at ninedays (range 3-23). In the UK (n=34), the equivalent figures were 100 hoursand eight days (range 3-13) (p=0.01).Both groups achieved enteral feeding at a median six days. The median length of hospital stay was 13 days in Sweden and 10 days in the UK (p=0.04). More babies were fully breastfeeding or breast-fed and bottle-fed at discharge in Sweden (85%) than the UK (67%) (p=0.08). There were no significant differences between the two groups regarding adverse events. Conclusion: Early minimal enteral feeding during hypothermia provedfeasible,with no significant complications. Delayed enteral feeding did not affect time to full enteral feeding. KEY NOTES: •
The safety and efficacy of enteral feeding during hypothermia treatment following hypoxic ischaemic encephalopathy has not been studied before, resulting invariations in practice.
•
We compared 51 Swedish infants, who received early enteral feeding during hypothermia, and 34 UK infants, who received delayed enteral feeding.
This article is protected by copyright. All rights reserved.
Accepted Article This article is protected by copyright. All rights reserved.
Accepted Article
Patients and Methods The study was designed as a retrospective cohort study involving UK and Swedish cohorts from neonatal units that followed similar hypothermia protocols but had different feeding practices during HT treatment. The UK neonatal unit wasthe Princess Anne Hospital in Southamptonand the Swedish units were at the Karolinska Hospital Huddinge, Karolinska HospitalSolnaand Stockholm South General Hospital. All the units used the same protocols andpractices forhypothermia treatment. All infants undergoing HT at the participating neonatal units between 1 January 2009 and31 December 2011 were included in the study. The criteria for HT used by the centres are in accordance with the guidelines set by the Total Body Hypothermia for Neonatal Encephalopathycooling registry(8). Eligible infants were born at 36 weeks of gestation or more, had evidence of perinatal asphyxia and displayed clinical signs of moderate or severe encephalopathy according to Levene’s modification of the Sarnat and Sarnat classification(9). A diagnosis of perinatal asphyxia was made if one of the following criteria were met: APGAR
