Department of Biology, McMaster University, Hamilton, Ontario, Canada.
Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Ther Hypothermia Temp Manag. 2023 Dec;13(4):216-224. doi: 10.1089/ther.2023.0008. Epub 2023 May 3.
This study investigates the clinical profile and predictors of gastrointestinal/hepatic morbidities and feeding outcomes among neonates with hypoxic-ischemic encephalopathy (HIE). A single-center retrospective chart review of consecutive neonates >35 weeks of gestation admitted with a diagnosis of HIE between January 1, 2015, and December 31, 2020, and treated with therapeutic hypothermia, if met the institutional eligibility criteria. Outcomes assessed included necrotizing enterocolitis (NEC), conjugated hyperbilirubinemia, hepatic dysfunction, assisted feeding at discharge, and time to reach full enteral and oral feeds. Among 240 eligible neonates (gestational age 38.7 [1.7] weeks, birth weight 3279 [551] g), 148 (62%) received hypothermia therapy, and 7 (3%) and 5 (2%) were diagnosed with stage 1 NEC and stage 2-3 NEC, respectively. Twenty-nine (12%) were discharged home with a gastrostomy/gavage tube, conjugated hyperbilirubinemia (first week 22 [9%], at discharge 19 [8%]), and hepatic dysfunction (74 [31%]). Time to reach full oral feeds was significantly longer in hypothermic neonates compared with neonates who did not receive hypothermia (9 [7-12] days vs. 4.5 [3-9] days, < 0.0001). Factors significantly associated with NEC were renal failure (odds ratio [OR] 9.24, 95% confidence interval [CI] 2.7-33), hepatic dysfunction (OR 5.69, 95% CI 1.6-26), and thrombocytopenia (OR 3.6, 95% CI 1.1-12), but no significant association with hypothermia, severity of brain injury, or stage of encephalopathy. Transient conjugated hyperbilirubinemia, hepatic dysfunction within first week of life, and need for assistive feeding are more common than NEC in HIE. Risk of NEC was associated with the severity of end-organ dysfunction in the first week of life, rather than severity of brain injury and hypothermia therapy .
这项研究调查了患有缺氧缺血性脑病（HIE）的新生儿的胃肠道/肝脏并发症和喂养结局的临床特征及预测因素。对 2015 年 1 月 1 日至 2020 年 12 月 31 日期间在我院住院、胎龄＞35 周、符合治疗性低温治疗条件的连续 HIE 新生儿进行了单中心回顾性图表审查。评估的结局包括坏死性小肠结肠炎（NEC）、结合性高胆红素血症、肝功能障碍、出院时辅助喂养以及达到完全肠内和口服喂养的时间。在 240 名符合条件的新生儿中（胎龄 38.7[1.7]周，出生体重 3279[551]g），148 名（62%）接受了低温治疗，分别有 7 名（3%）和 5 名（2%）新生儿被诊断为 1 期 NEC 和 2-3 期 NEC。29 名（12%）新生儿出院时带有胃造口/胃管，伴有结合性高胆红素血症（第 1 周 22 例[9%]，出院时 19 例[8%]）和肝功能障碍（74 例[31%]）。与未接受低温治疗的新生儿相比，接受低温治疗的新生儿达到完全口服喂养的时间明显更长（9[7-12]天 vs. 4.5[3-9]天， < 0.0001）。与 NEC 显著相关的因素是肾衰竭（比值比 [OR] 9.24，95%置信区间 [CI] 2.7-33）、肝功能障碍（OR 5.69，95% CI 1.6-26）和血小板减少症（OR 3.6，95% CI 1.1-12），但与低温、脑损伤严重程度或脑病分期无显著相关性。在 HIE 中，短暂性结合性高胆红素血症、生命第一周的肝功能障碍和需要辅助喂养比 NEC 更常见。NEC 的风险与生命第一周终末器官功能障碍的严重程度相关，而不是与脑损伤和低温治疗的严重程度相关。
