Thornton Kimberly M, Dai Hongying, Septer Seth, Petrikin Joshua E
Department of Neonatology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA ; School of Medicine, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
Research Development and Clinical Investigation, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
Int J Pediatr. 2014;2014:643689. doi: 10.1155/2014/643689. Epub 2014 Aug 25.
Objective. This retrospective cohort study evaluated the effects of whole body therapeutic hypothermia (WBTH) on gastrointestinal (GI) morbidity and feeding tolerance in infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Study Design. Infants ≥ 35 weeks gestational age and ≥1800 grams birth weight with moderate-to-severe HIE treated from 2000 to 2012 were compared. 68 patients had documented strictly defined criteria for WBTH: 32 historical control patients did not receive WBTH (non-WBTH) and 36 cohort patients received WBTH. Result. More of the non-WBTH group infants never initiated enteral feeds (28% versus 6%; P = 0.02), never reached full enteral feeds (38% versus 6%, P = 0.002), and never reached full oral feeds (56% versus 19%, P = 0.002). Survival analyses demonstrated that the WBTH group reached full enteral feeds (median time: 11 versus 9 days; P = 0.02) and full oral feeds (median time: 19 versus 10 days; P = 0.01) sooner. The non-WBTH group had higher combined outcomes of death and gastric tube placement (47% versus 11%; P = 0.001) and death and gavage feeds at discharge (44% versus 11%; P = 0.005). Conclusion. WBTH may have beneficial effects on GI morbidity and feeding tolerance for infants with moderate-to-severe HIE.
目的。这项回顾性队列研究评估了全身治疗性低温（WBTH）对中重度缺氧缺血性脑病（HIE）婴儿胃肠道（GI）发病率和喂养耐受性的影响。研究设计。比较了2000年至2012年治疗的胎龄≥35周、出生体重≥1800克的中重度HIE婴儿。68例患者有严格定义的WBTH标准记录：32例历史对照患者未接受WBTH（非WBTH组），36例队列患者接受了WBTH。结果。非WBTH组更多婴儿从未开始肠内喂养（28%对6%；P = 0.02），从未达到完全肠内喂养（38%对6%，P = 0.002），从未达到完全经口喂养（56%对19%，P = 0.002）。生存分析表明，WBTH组更快达到完全肠内喂养（中位时间：11天对9天；P = 0.02）和完全经口喂养（中位时间：19天对10天；P = 0.01）。非WBTH组死亡和放置胃管的联合结局更高（分别为47%和11%；P = 0.001），出院时死亡和管饲喂养的联合结局也更高（44%对11%；P = 0.005）。结论。WBTH可能对中重度HIE婴儿的胃肠道发病率和喂养耐受性有有益影响。
