Children's National Hospital Child Neurology Residency Program, Washington, District of Columbia.
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
Am J Perinatol. 2022 Nov;39(15):1678-1681. doi: 10.1055/s-0041-1725161. Epub 2021 Mar 3.
Infants with a history of neonatal hypoxic-ischemic encephalopathy (HIE) are at risk for oral motor dysfunction. Previous studies have associated the need for gastrostomy tube at neonatal intensive care unit discharge with brainstem injury on magnetic resonance imaging (MRI). However, the factors associated with time to full oral feeds in this population have not been previously described. This study aimed to study factors associated with time to full oral feeds in this population.
This is a single-center, retrospective study that examined these factors using Cox regression.
A total of 150 infants who received therapeutic hypothermia from 2011 to 2017 were included in this study. The single clinical factor significantly associated with time to full oral feeds was the severity of background abnormality on electroencephalogram in the first 24 hours of age (severe vs. mild 95% confidence interval [CI]: 0.34-0.74; moderate vs. mild 95% CI: 0.19-0.45). Brainstem injury on MRI was the factor most highly associated with need for gastrostomy tube placement ( = 0.028), though the overall incidence of need for gastrostomy tube feeds in this population was low (5%).
These findings may help clinicians counsel families on what to expect in neonates with HIE and make decisions on the need for and timing to pursue gastrostomy tube in this population.
· The overall incidence of the need for assisted feeding at NICU discharge is low in this population.. · MRI brainstem injury was most highly associated with need for gastrostomy tube placement.. · Worsening severity of background abnormality on EEG was associated with longer time to oral feeds..
有新生儿缺氧缺血性脑病（HIE）病史的婴儿存在口腔运动功能障碍的风险。既往研究表明，新生儿重症监护病房（NICU）出院时需要胃造口管与磁共振成像（MRI）上的脑干损伤有关。然而，该人群达到完全口服喂养所需时间的相关因素尚未被描述。本研究旨在探讨该人群达到完全口服喂养所需时间的相关因素。
这是一项单中心回顾性研究，使用 Cox 回归分析了这些因素。
本研究共纳入了 150 名在 2011 年至 2017 年接受了治疗性低温治疗的婴儿。与达到完全口服喂养时间显著相关的单一临床因素是生后 24 小时内脑电图的背景活动异常严重程度（严重 vs. 轻度 95%置信区间[CI]：0.34-0.74；中度 vs. 轻度 95%CI：0.19-0.45）。MRI 上的脑干损伤是与胃造口管放置需求最相关的因素（ = 0.028），尽管该人群中胃造口管喂养的总体需求发生率较低（5%）。
这些发现可能有助于临床医生为 HIE 新生儿的家属提供指导，并就该人群中胃造口管的需求和时机做出决策。
· 在该人群中，NICU 出院时需要辅助喂养的总体发生率较低。· MRI 脑干损伤与胃造口管放置需求最相关。· EEG 背景活动异常严重程度的恶化与达到口服喂养所需时间较长相关。
