626 - Short-term Outcomes of Early Rapid Feeding in Neonatal Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Publication Number: 626.6633

Yixian Zhu, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (People's Republic); Yi Sun, Guangzhou Women and Children‘s Medicial Center, Guangzhou Medical University, Guangzhou, Guangdong, China (People's Republic)

Background: With the widespread use of Therapeutic Hypothermia(TH) in the treatment of neonatal Hypoxic-Ischemic Encephalopathy(HIE), increasing evidence suggests that early feeding during TH therapy in these infants is safe and does not increase the risk of adverse gastrointestinal events such as necrotizing enterocolitis(NEC). However, current research primarily focuses on feeding versus non-feeding, lacks more exploration into the effects of initial feeding volumes, feeding advancement rates, and other details.

Objective: To investigate the impact of early rapid feeding on feeding intolerance(FI), NEC, and other outcomes in HIE infants undergoing TH, to provide a scientific basis for establishing better feeding protocol for these infants.

Design/Methods: Cases of infants diagnosed with HIE who underwent TH at our department between January 1, 2016 and December 30, 2023, were selected for a retrospective cohort study. Based on the feeding of these infants, they were divided into three groups: 1. Early Rapid Feeding (ERF) group: Fed within 48 hours after TH initiation, with a feeding advancement speed exceeding 15 ml/kg/day for the initial three feeding days (including those patients with a temporary advancing speed less than 15 ml/kg/day due to feeding intolerance) ; 2. Early Slow Feeding (ESF) group: Fed within 48 hours after TH initiation, with feeding advancement speed less than 15 ml/kg/day ; 3.Delayed Feeding (DF) group: Infants who commenced feeding after 48 hours following TH initiation. Statistically compared differences among these groups including FI incidence before 2 weeks of age or discharge to home (whichever came first), NEC incidence, late-onset sepsis incidence, duration of parenteral nutrition(PN) use, age to full enteral feeding, and length of hospital stay, etc.

Results: A total of 65 patients were included in this study, 18 in the ERF, 19 in the ESF, and 28 in the DF group. In this study, 24.6% of infants developed FI, 27.7% in the ERF, 26.3% in the ESF, and 21.4% in the DF group. There was no difference in the incidence of FI among three groups (P=0.874). No cases of NEC were observed. The ERF group had a shorter duration of PN use and time to reach full enteral feeding compared to other groups.

Conclusion(s): Early rapid enteral feeding in neonates with HIE treated with TH may be safe and beneficial, as it does not increase the risk of FI and NEC incidence compared to early slow feeding and delayed feeding. Meanwhile, it could shorten the duration of PN use, the age to full enteral feeding, and the length of hospital stay.

Table 1- Comparison of feeding status among 3 groups


Tabel 2- comparison of short-term outcomes among 3 groups