在治疗性低体温期间进行喂养是安全的，并且可能改善围产期窒息的新生儿的结局。
Feeding during therapeutic hypothermia is safe and may improve outcomes in newborns with perinatal asphyxia.
机构信息
Dalhousie and Memorial Universities, New Brunswick, Canada.
Alberta Health Services, Alberta Children Hospital, Calgary, Canada.
出版信息
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9440-9444. doi: 10.1080/14767058.2022.2041594. Epub 2022 Feb 14.
OBJECTIVE
We assessed the impact of early enteral feeding introduction during therapeutic hypothermia on time to reach full enteral feeding (FEF) and other feeding related outcomes in infants born at ≥35 weeks gestational age and diagnosed with moderate to severe Hypoxic-Ischemic Encephalopathy.
METHODS
A prospective cohort with historical control study, conducted on infants admitted to the Alberta Children's Hospital level III NICU in Calgary between January 2013 and December 2018. Infants were divided into 2 groups: (1) unfed group (UG), which was kept nil per os during the 72 h of therapeutic Hypothermia (TH), with subsequent introduction of feeding and gradual increase to FEF; (2) fed group (FG), which received feeding at 10 mL/kg/day during TH then increased gradually to FEF. Groups were compared for time to FEF and the type of milk they were being fed on discharge. Other gut related health risks such as NEC and sepsis were examined.
RESULTS
During the study period, 146 infants received therapeutic hypothermia, of whom 75 in the UG and 71 in the FG. The FG compared to the UG received the first feed sooner after TH initiation (median 57 vs. 86.5 h, < .001), reached FEF earlier (median 6 vs. 8 days, = .012), had a higher rate of being fully fed in the first week of life (70 vs. 53%, < .035), was kept NPO for shorter duration (median 2 vs. 4 days, < .001), and had a higher rate of breast milk feeding at discharge (41 vs. 13%, < .001). There were no cases of necrotizing enterocolitis or late onset sepsis in either group during the hospital stay.
CONCLUSION
Minimal enteral feeding during therapeutic hypothermia appears to be safe and leads to a shorter time to FEF and higher rates of breast milk feeding at discharge.
目的
我们评估了在治疗性低温期间尽早开始肠内喂养对胎龄≥35 周且诊断为中重度缺氧缺血性脑病的婴儿达到完全肠内喂养（FEF）的时间和其他喂养相关结果的影响。
方法
这是一项前瞻性队列研究，设有历史对照，在 2013 年 1 月至 2018 年 12 月期间，在卡尔加里的艾伯塔省儿童医院三级新生儿重症监护病房（NICU）中对婴儿进行。将婴儿分为 2 组：（1）未喂养组（UG），在治疗性低温（TH）的 72 小时内保持无口服喂养，随后开始喂养并逐渐增加至 FEF；（2）喂养组（FG），在 TH 期间接受 10mL/kg/天的喂养，然后逐渐增加至 FEF。比较两组达到 FEF 的时间以及出院时喂养的奶的类型。还检查了其他与肠道相关的健康风险，如 NEC 和败血症。
结果
在研究期间，146 名婴儿接受了治疗性低温治疗，其中 UG 组 75 例，FG 组 71 例。FG 组与 UG 组相比，在 TH 开始后更早地接受了第一次喂养（中位数 57 与 86.5 小时，<0.001），更早地达到了 FEF（中位数 6 与 8 天，=0.012），在生命的第一周完全喂养的比例更高（70 与 53%，<0.035），NPO 时间更短（中位数 2 与 4 天，<0.001），出院时母乳喂养的比例更高（41 与 13%，<0.001）。在住院期间，两组均未发生坏死性小肠结肠炎或晚发性败血症。
结论
在治疗性低温期间进行最低限度的肠内喂养似乎是安全的，可缩短达到 FEF 的时间，并提高出院时母乳喂养的比例。
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