Martinovski Helen, Khanal Luna, Kraft Debra, Natarajan Girija
Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
Department of Pediatrics, Central Michigan University, Mount Pleasant, Michigan.
Am J Perinatol. 2025 Aug;42(11):1477-1484. doi: 10.1055/a-2510-1543. Epub 2025 Jan 6.
This study aimed to describe feeding outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and compare characteristics and outcomes in groups discharged home on oral, total/partial nasogastric, and gastrostomy tube feedings.This was a retrospective, single-center cohort study of infants diagnosed with moderate or severe HIE using standard criteria who underwent cooling from January 2017 to June 2022. Data were abstracted from hospital course as well as until 6 months follow-up. Statistical analysis included chi-square test and ANOVA with post hoc Bonferroni correction for between-group comparisons.Among 123 included infants, 95 (77%) fed orally, 11 (9%) required total/partial nasogastric feeds and 17 (14%) had gastrostomy tubes at discharge. A significantly greater proportion of infants with gastrostomy-tube feeds at discharge had intrapartum complications, Apgar scores <5 at 5 and 10 minutes, severe rather than moderate HIE, and seizures. They also had a longer hospital stay, prolonged respiratory support and intubated days, and delayed initiation of feeding. Infants discharged on nasogastric feeds all attained oral feeds at a median (IQR) duration of 54 (6-178) days follow-up. Among the 106 (86%) infants with follow-up data, the gastrostomy group had significantly lower median weight and head circumference centiles compared to the others. Criteria for gavage eligibility were met before discharge in 98 (80%) of the cohort; 42% stayed beyond this benchmark.Earlier identification of eventual gastrostomy tube insertion as well as discharge home on nasogastric feedings may reduce duration of hospitalization in infants with HIE. Our data may provide insights to guide practice improvement for enteral feedings in this population. · In neonatal encephalopathy, impaired oral feedings is common.. · Antepartum complications and HIE severity are associated with gastrostomy insertion.. · Discharge home on gavage feeds could shorten hospital stay..
本研究旨在描述缺氧缺血性脑病（HIE）新生儿的喂养结局，并比较经口喂养、全/部分鼻饲喂养和胃造口管喂养出院的各组患儿的特征和结局。这是一项回顾性单中心队列研究，研究对象为2017年1月至2022年6月期间，按照标准诊断为中度或重度HIE且接受了亚低温治疗的婴儿。数据从住院病程中提取，并随访至6个月。统计分析包括卡方检验和方差分析，并采用事后Bonferroni校正进行组间比较。在纳入研究的123例婴儿中，95例（77%）经口喂养，11例（9%）需要全/部分鼻饲喂养，17例（14%）出院时置入胃造口管。出院时接受胃造口管喂养的婴儿中，有更高比例的患儿存在产时并发症、5分钟和10分钟时阿氏评分<5分、重度而非中度HIE以及惊厥。他们的住院时间也更长，呼吸支持和插管天数延长，开始喂养的时间延迟。鼻饲喂养出院的婴儿在中位（IQR）随访54（6 - 178）天时均实现了经口喂养。在有随访数据的106例（86%）婴儿中，胃造口组的中位体重和头围百分位数显著低于其他组。队列中98例（80%）患儿在出院前符合管饲喂养的标准；42%的患儿住院时间超过了这个基准。尽早确定最终需要置入胃造口管以及鼻饲喂养出院，可能会缩短HIE婴儿的住院时间。我们的数据可能为指导该人群肠内喂养的实践改进提供见解。· 在新生儿脑病中，经口喂养受损很常见。· 产前并发症和HIE严重程度与胃造口管置入有关。· 鼻饲喂养出院可缩短住院时间。
