Background: Therapeutic hypothermia is the standard of care treatment for infants with hypoxic-ischemic encephalopathy (HIE). These infants are at risk for gut and brain injury and may experience delayed oral feeding skills, delayed initiation of breastfeeding, and abnormal growth. However, very little is known about the growth and feeding outcomes of these infants.
Objective: To evaluate 1) the prevalence of requiring specialized feeding support during and after the neonatal intensive care unit (NICU) hospitalization and 2) growth trajectories through 1 year old, among infants treated with therapeutic hypothermia.
Design/Methods: We performed a retrospective analysis of all infants treated with therapeutic hypothermia from January 2018-February 2019 in our level III NICU who also attended our follow-up clinic. Our center offers comprehensive allied health support including lactation specialists, nutritionists and feeding therapists in the NICU and at follow-up visits scheduled every 2-6 months after discharge. We recorded any specialized feeding support (tube feeds, specialized nipple, and performance of a swallow study [representing high concern for aspiration]) utilized in the NICU and at discharge. We documented feeding type (breastmilk and/or formula) at discharge and each clinic visit. Weight, length, and head circumference at birth, discharge, and each clinic visit were converted to Z-scores using the World Health Organization growth standards, from which we calculated mean growth trajectories.
Results: Infants (N=26) had mean gestational age 39.4 weeks (standard deviation [SD] 1.8 weeks) and birthweight Z-score -0.2 (SD 1.0). Most infants (77%) required specialized feeding support in the NICU, including 42% who required nasogastric (NG) tube feeds. Most feeding issues resolved by discharge, but 27% of infants had ongoing specialized needs at discharge and 4% were discharged with an NG tube. Breastfeeding rates were high: 88% of infants received some breastmilk at discharge and 60-72% continued to breastfeed at each follow-up (Table). Average growth trajectories were similar to reference data for healthy full-term infants (Figure).
Conclusion: Oral feeding difficulties during hospitalization are common for infants undergoing therapeutic hypothermia and may persist beyond discharge. In our center with routine provision of intensive feeding support in the NICU and at follow-up, infants who experienced HIE achieved growth similar to the expected growth of healthy full-term infants. This high-risk population may benefit from routine provision of intensive feeding support during and after NICU hospitalization.
