Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen
IntroductionEnteral feeding during therapeutic hypothermia (TH) for neonatal hypoxic ischaemic encephalopathy (HIE), is beneficial, but there is insufficient evidence to guide timing and feed advancement strategies. The aim of this study was to describe feed tolerance and outcomes after TH with a st...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1611619/full |
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| author | Ilhaam Samaai Michael S. Pepper Michael S. Pepper Shakti Pillay Alan R. Horn |
| author_facet | Ilhaam Samaai Michael S. Pepper Michael S. Pepper Shakti Pillay Alan R. Horn |
| author_sort | Ilhaam Samaai |
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| description | IntroductionEnteral feeding during therapeutic hypothermia (TH) for neonatal hypoxic ischaemic encephalopathy (HIE), is beneficial, but there is insufficient evidence to guide timing and feed advancement strategies. The aim of this study was to describe feed tolerance and outcomes after TH with a standardized progressive early enteral feeding regimen.MethodsData were retrospectively reviewed from neonates with HIE who were treated with TH for HIE in the Groote Schuur Hospital (GSH) Neonatal intensive care unit (NICU), between 1 July 2019 and 31 October 2022. Enteral feeds were commenced at age 12–24 h and incremented daily if tolerated, at 12 ml/kg/day for the first 3 days and 24 ml/kg thereafter. Nutritional, morbidity and mortality outcomes were compared between neonates with and without early feed intolerance (EFI) by the fourth day of life.ResultsThirty three percent (16/48) developed EFI. However, by day six the median (IQR) enteral volumes were, 120 (110–120) and 90 (90–99), in neonates without and with feed intolerance respectively. There were no differences in resuscitation characteristics. Neonates with EFI, had higher HIE grades, more amplitude integrated electro-encephalograph (aEEG) suppression at 48 h (p = 0.002), later attainment of full nutritive sucking or cup feeds (p < 0.001) and longer hospital stays (p = 0.038). There were no differences in other morbidities. Mortality was 6% and necrotising enterocolitis did not occur in either group.ConclusionsEarly feeding was generally well tolerated. Feed intolerance was more frequent in neonates with severe HIE, but most neonates achieved independence from IV fluids by day six. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-fe8d8875aee04676b836317aa89f8bb62025-08-20T03:56:09ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-07-011310.3389/fped.2025.16116191611619Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimenIlhaam Samaai0Michael S. Pepper1Michael S. Pepper2Shakti Pillay3Alan R. Horn4Department of Paediatrics and Child Health, Division of Neonatal Medicine, University of Cape Town, Cape Town, South AfricaDepartment of Medical Immunology, Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South AfricaExtramural Unit for Stem Cell Research and Therapy, South African Medical Research Council, Pretoria, South AfricaDepartment of Paediatrics and Child Health, Division of Neonatal Medicine, University of Cape Town, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Division of Neonatal Medicine, University of Cape Town, Cape Town, South AfricaIntroductionEnteral feeding during therapeutic hypothermia (TH) for neonatal hypoxic ischaemic encephalopathy (HIE), is beneficial, but there is insufficient evidence to guide timing and feed advancement strategies. The aim of this study was to describe feed tolerance and outcomes after TH with a standardized progressive early enteral feeding regimen.MethodsData were retrospectively reviewed from neonates with HIE who were treated with TH for HIE in the Groote Schuur Hospital (GSH) Neonatal intensive care unit (NICU), between 1 July 2019 and 31 October 2022. Enteral feeds were commenced at age 12–24 h and incremented daily if tolerated, at 12 ml/kg/day for the first 3 days and 24 ml/kg thereafter. Nutritional, morbidity and mortality outcomes were compared between neonates with and without early feed intolerance (EFI) by the fourth day of life.ResultsThirty three percent (16/48) developed EFI. However, by day six the median (IQR) enteral volumes were, 120 (110–120) and 90 (90–99), in neonates without and with feed intolerance respectively. There were no differences in resuscitation characteristics. Neonates with EFI, had higher HIE grades, more amplitude integrated electro-encephalograph (aEEG) suppression at 48 h (p = 0.002), later attainment of full nutritive sucking or cup feeds (p < 0.001) and longer hospital stays (p = 0.038). There were no differences in other morbidities. Mortality was 6% and necrotising enterocolitis did not occur in either group.ConclusionsEarly feeding was generally well tolerated. Feed intolerance was more frequent in neonates with severe HIE, but most neonates achieved independence from IV fluids by day six.https://www.frontiersin.org/articles/10.3389/fped.2025.1611619/fullneonatehypoxia ischaemia -brainhypothermia -inducedAfrica south of the Saharaneonatal encephalopathynutrition-enteral |
| spellingShingle | Ilhaam Samaai Michael S. Pepper Michael S. Pepper Shakti Pillay Alan R. Horn Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen Frontiers in Pediatrics neonate hypoxia ischaemia -brain hypothermia -induced Africa south of the Sahara neonatal encephalopathy nutrition-enteral |
| title | Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen |
| title_full | Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen |
| title_fullStr | Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen |
| title_full_unstemmed | Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen |
| title_short | Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen |
| title_sort | minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a south african cohort with a standardised feeding regimen |
| topic | neonate hypoxia ischaemia -brain hypothermia -induced Africa south of the Sahara neonatal encephalopathy nutrition-enteral |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1611619/full |
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