Enteral nutrition during therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy: The need for more evidence

Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation: A case series

PURPOSE

To describe the evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy (HIE) during hospitalisation.

METHOD

A longitudinal cohort study was used. Twenty-nine participants (median age 39.0 weeks [IQR = 2.0 weeks]) with mild (n = 7), moderate (n = 19) and severe (n = 3) HIE were included. Clinical swallowing and feeding assessments were conducted at introduction of oral feeds and at discharge using the Neonatal Feeding Assessment Scale (NFAS). Videofluoroscopic swallow studies (VFSS) supplemented the NFAS before discharge.

RESULT

Approximately two thirds of participants showed symptoms of oropharyngeal dysphagia (OPD) during initial NFAS and VFSS. Significantly fewer OPD symptoms occurred at discharge NFAS (p = 0.004). Endurance during non-nutritive sucking (p < 0.001) and nutritive sucking (p < 0.001) significantly improved. Nine participants (31.0%) demonstrated penetration or aspiration. Most aspiration events were silent (60%). Instrumental assessment identified pharyngeal phase dysphagia more effectively than bedside evaluation. High proportions of participants displayed OPD symptoms regardless of HIE severity. The correlation between OPD severity and the length of hospitalisation (p = 0.052) was not significant.

CONCLUSION

All grades of HIE should be considered for early intervention by speech-language pathologists before discharge. Findings may be valuable to neonatal feeding teams.

Early versus delayed enteral nutrition for neonatal hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia: a randomized controlled trial

Background

The practice of therapeutic hypothermia (TH) is widely used for neonatal hypoxic-ischemic encephalopathy (HIE) despite its corresponding feeding strategies are still controversial. This randomized controlled trial (RCT) demonstrated to evaluate the effect of early vs. delayed enteral nutrition on the incidence of feeding intolerance (FI) and other association during TH.

Methods

This single center, parallel-group, and no-blinded RCT was processed in a level III, and academic neonatal intensive care unit. Infants who were diagnosed with HIE and undertaken TH from September 2020 to August 2021 were enrolled. Participants were randomized to receive enteral nutrition either during TH/rewarming (early enteral nutrition, EEN) or after TH (delayed enteral nutrition, DEN) according to a recommend enteral feeding protocol. All data were analyzed using SPSS 26.0 software with a p-value< 0.05 was considered statistically significant.

Results

Ninety-two infants were enrolled after randomization, but 12 (13.04%) cases including 3 (3.26%) deaths were excluded from eventually analyzed, who did not initiate or discontinue the intervention. 80 cases (42 and 38 in the EEN and DEN group, respectively) who completed the interventions were eventually analyzed. Besides initial time of enteral feeds, two groups had processed the same feeding method. Total 23 (25.0%) cases developed FI, and no difference of morbidity was found between two groups (23.4% vs 26.7%, p = 0.595; Log Rank, p = 0.803). There was no case died or developed late-onset bloodstream and no difference of the incidence of hypoglycemia or weight gain was found (p > 0.05). The percentage of infants who had not reaching the goal of full enteral feeding volume between the two groups was similar (21.43% vs 23.68%, p = 0.809). The average time of parenteral nutrition, reaching full enteral feeds and hospital stay were shorter in the EEN group compared with the DEN group with significant differences (8.81 ± 1.67 vs 10.61 ± 2.06 days, p < 0.001; 9.91 ± 1.88 vs 12.24 ± 2.50 days, p < 0.001; 12.55 ± 4.57 vs 16.47 ± 5.27 days, p = 0.001 respectively).

Conclusions

Compared with delayed enteral nutrition, introduction of early enteral nutrition according to a recommend feeding strategy for neonatal HIE undergoing TH may be feasible and safe.FI is frequent in this high-risk group of infants which should not be ignored during feeding process.

Trial registration

The Chinese Clinical Trial Registry,ChiCTR2000038193, 2020-9-13, https://www.chictr.org.cn.

Application of Touching Combined with Intelligent Interaction of Voice and Rhythm in Nursing Care of Newborns with Feeding Intolerance and Its Influence on Quality of Life

Objective

To explore the application of touching combined with intelligent interaction of voice and rhythm in the nursing of neonatal feeding intolerance and its effect on the quality of life.

Methods

A total of 140 newborns with feeding intolerance treated in our hospital from April 2019 to April 2021 were selected. The patients were randomly divided into two groups: the control group and the study group. The control group received touch nursing and the study group received touch combined with intelligent interactive nursing mode of voice, music, and rhythm. The general data, feeding performance, feeding process, growth and development, feeding intolerance, total intestinal feeding, jaundice duration, hospital stay, and quality of life scores were compared between the two groups.

Results

First of all, we compared the general data of the two groups. There was no significant difference in gestational age, sex, mode of delivery, birth weight, head circumference, body length, Apgar score, and other general data between the two groups. Second, we compared the feeding performance of the two groups. Before nursing, there was no significant difference between the two groups (P > 0.05). After nursing, the feeding rate, milk intake ratio, and proficiency of the two groups increased, and the comparison between the two groups. The feeding rate, milk intake ratio, and proficiency of the study group were better than those of the control group. In terms of the feeding process of the two groups, the days of oral feeding, complete import feeding, feeding conversion, and indwelling gastric tube in the study group were lower than those in the control group (P < 0.05). In terms of the growth and development of the two groups, the recovery time of birth weight in the study group was lower than that in the control group, and the growth of body weight, length, and head circumference at 14 days in the study group was higher than those in the control group. The feeding intolerance, the duration of jaundice, and the days of hospitalization in the study group were lower than those in the control group (P < 0.05). Moreover, the feeding intolerance, the duration of jaundice, and the days of hospitalization in the study group were lower than those in the control group (P < 0.05). Finally, we compared the scores of qualities of life between the two groups. The physiological function, psychological function, and social function of the study group were lower than those of the control group (P < 0.05). The physiological function, psychological function, and social function of the study group were lower than those of the control group (P < 0.05).

Conclusion

The application of touching combined with phonetic rhythm intelligent interaction technology in the nursing of neonatal feeding intolerance can promote the faster development and maturity of neonatal gastrointestinal function, improve gastrointestinal motility, shorten the time of parenteral nutrition in newborns, achieve total enteral feeding faster, and promote neonatal growth and development, so as to shorten the duration of hospitalization, improve the tolerance of neonatal gastrointestinal feeding, and improve the quality of life.