170 Predicting Feeding Problems in Infants with Central Grey Matter Damage Following Hypoxic-Ischaemic Encephalopathy (HIE)

Abstract

Background and aims: Feeding problems are common following HIE and are a huge burden for infants and families. We aimed to evaluate, in term newborns with HIE and basal ganglia/thalamic (BGT) lesions, the relation between feeding difficulties and early MRI findings.Methods: From 1993-2007, all term infants with evidence of perinatal asphyxia, HIE and BGT injury seen on MRI within 6 postnatal weeks were included. BGT, white matter, internal capsule, cortex and brainstem lesions were classified by severity. Cerebral palsy (CP) severity was determined from the Gross Motor Function Classification System (GMFCS).Results: 175 infants fulfilled the entry criteria. 49 died (23 neonatally, 26 in infancy). Feeding problems occurred in all who died, both early and late, and in 65% of survivors; 44% had difficulty with liquids, 48% with solids and 27% only tolerated pureed foods. 33% had a gastrostomy (median age 11 (range 3-48) months). All but 3 of the 82 children with feeding problems had CP, 91% GMFCS level IV/V. In a logistic regression model BGT/mesencephalic injury was associated with feeding problems (p< 0.001) and BGT/pons injury with gastrostomy (p< 0.001). The need for gastrostomy occurred in only 3.5% of infants with mild/moderate BGT + normal pons but in 90.6% of surviving infants with severe BGT+ pons injury.Conclusions: The occurrence and severity of feeding problems in neonates with HIE and BGT injury relates to the severity of the BGT/brainstem lesions. These findings enable planning of care and a better approach to nutrition in these children.