Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, UK.
Neonatal Data Analysis Unit, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, UK.
Lancet Child Adolesc Health. 2021 Jun;5(6):408-416. doi: 10.1016/S2352-4642(21)00026-2. Epub 2021 Apr 21.
Therapeutic hypothermia is standard of care in high-income countries for babies born with signs of hypoxic ischaemic encephalopathy, but optimal feeding during treatment is uncertain and practice is variable. This study aimed to assess the association between feeding during therapeutic hypothermia and clinically important outcomes.
We did a population-level retrospective cohort study using the UK National Neonatal Research Database. We included all babies admitted to National Health Service neonatal units in England, Scotland, and Wales between Jan 1, 2010, and Dec 31, 2017, who received therapeutic hypothermia for 72 h or died during this period. For analysis, we created matched groups using propensity scores and compared outcomes in babies who were fed versus unfed enterally during therapeutic hypothermia. The primary outcome was severe necrotising enterocolitis, either confirmed at surgery or causing death. Secondary outcomes include pragmatically defined necrotising enterocolitis (a recorded diagnosis of necrotising enterocolitis in babies who received at least 5 consecutive days of antibiotics while also nil by mouth during their neonatal unit stay), late-onset infection (pragmatically defined as 5 consecutive days of antibiotic treatment commencing after day 3), survival to discharge, measures of breastmilk feeding, and length of stay in neonatal unit.
6030 babies received therapeutic hypothermia, of whom 1873 (31·1%) were fed during treatment. Seven (0·1%) babies were diagnosed with severe necrotising enterocolitis and the number was too small for further analyses. We selected 3236 (53·7%) babies for the matched feeding analysis (1618 pairs), achieving a good balance for all recorded background variables. Pragmatically defined necrotising enterocolitis was rare in both groups (incidence 0·5%, 95% CI 0·2-0·9] in the fed group vs 1·1% [0·7-1·4] in the unfed group). The enterally fed group had fewer pragmatically defined late-onset infections (difference -11·6% [95% CI -14·0 to -9·3]; p<0·0001), higher survival to discharge (5·2% [3·9-6·6]; p<0·0001), higher proportion of breastfeeding at discharge (8·0% [5·1-10·8]; p<0·0001), and shorter neonatal unit stays (-2·2 [-3·0 to -1·2] days; p<0·0001) compared with the unfed group.
Necrotising enterocolitis is rare in babies receiving therapeutic hypothermia. Enteral feeding during hypothermia is safe and associated with beneficial outcomes compared with not feeding, although residual confounding could not be completely ruled out. Our findings support starting milk feeds during therapeutic hypothermia.
UK National Institute for Health Research Health Technology Assessment programme 16/79/13.
在高收入国家，对于有缺氧缺血性脑病迹象的婴儿，治疗性低温是标准治疗方法，但治疗期间的最佳喂养方式尚不确定，且实践方法存在差异。本研究旨在评估治疗性低温期间的喂养与临床重要结局之间的关联。
我们在英国国家新生儿研究数据库中进行了一项基于人群的回顾性队列研究。我们纳入了 2010 年 1 月 1 日至 2017 年 12 月 31 日期间在英格兰、苏格兰和威尔士的国民保健服务新生儿病房住院、接受了 72 小时或在此期间死亡的接受治疗性低温的所有婴儿。为了分析，我们使用倾向评分创建了匹配组，并比较了在治疗性低温期间接受和未接受肠内喂养的婴儿的结局。主要结局是严重坏死性小肠结肠炎，通过手术确认或导致死亡。次要结局包括临床上定义的坏死性小肠结肠炎（在新生儿病房住院期间接受至少连续 5 天抗生素治疗且同时禁食的婴儿中记录的坏死性小肠结肠炎诊断）、晚发性感染（定义为在第 3 天后开始连续 5 天的抗生素治疗）、出院存活率、母乳喂养措施和新生儿病房住院时间。
6030 名婴儿接受了治疗性低温治疗，其中 1873 名（31.1%）在治疗期间接受了喂养。7 名（0.1%）婴儿被诊断为严重坏死性小肠结肠炎，数量太少无法进一步分析。我们选择了 3236 名（53.7%）婴儿进行匹配喂养分析（1618 对），所有记录的背景变量均达到了良好的平衡。在两组中，临床上定义的坏死性小肠结肠炎均很少见（喂养组的发生率为 0.5%[95%CI，0.2-0.9]，未喂养组为 1.1%[0.7-1.4]）。肠内喂养组的临床上定义的晚发性感染发生率较低（差异-11.6%[95%CI，-14.0 至-9.3]；p<0.0001），出院存活率较高（5.2%[3.9-6.6]；p<0.0001），出院时母乳喂养比例较高（8.0%[5.1-10.8]；p<0.0001），新生儿病房住院时间较短（-2.2[-3.0 至-1.2]天；p<0.0001），与未喂养组相比。
在接受治疗性低温治疗的婴儿中，坏死性小肠结肠炎很少见。与不喂养相比，低温期间进行肠内喂养是安全的，并与有益的结局相关，尽管仍不能完全排除残留混杂因素的影响。我们的研究结果支持在治疗性低温期间开始喂养母乳。
英国国家卫生研究院健康技术评估计划 16/79/13。
