Effects of whole body therapeutic hypothermia on gastrointestinal morbidity and feeding tolerance in infants with hypoxic ischemic encephalopathy.

Kimberly M Thornton,Joshua E Petrikin,Hongying Dai,Seth Septer

doi:10.1155/2014/643689

Abstract

Objective. This retrospective cohort study evaluated the effects of whole body therapeutic hypothermia (WBTH) on gastrointestinal (GI) morbidity and feeding tolerance in infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Study Design. Infants ≥ 35 weeks gestational age and ≥1800 grams birth weight with moderate-to-severe HIE treated from 2000 to 2012 were compared. 68 patients had documented strictly defined criteria for WBTH: 32 historical control patients did not receive WBTH (non-WBTH) and 36 cohort patients received WBTH. Result. More of the non-WBTH group infants never initiated enteral feeds (28% versus 6%; P = 0.02), never reached full enteral feeds (38% versus 6%, P = 0.002), and never reached full oral feeds (56% versus 19%, P = 0.002). Survival analyses demonstrated that the WBTH group reached full enteral feeds (median time: 11 versus 9 days; P = 0.02) and full oral feeds (median time: 19 versus 10 days; P = 0.01) sooner. The non-WBTH group had higher combined outcomes of death and gastric tube placement (47% versus 11%; P = 0.001) and death and gavage feeds at discharge (44% versus 11%; P = 0.005). Conclusion. WBTH may have beneficial effects on GI morbidity and feeding tolerance for infants with moderate-to-severe HIE.

Highlights

Perinatal hypoxic ischemic encephalopathy (HIE) is associated with high morbidity and mortality in the neonatal period as well as long-term neurocognitive deficits
There were 435 total patients identified for retrospective analysis: 347 in the non-whole body therapeutic hypothermia (WBTH) group and 88 in the WBTH group. 287 total patients were excluded from the study because they did not meet criteria for moderate-to-severe HIE, because they had a significant congenital defect at birth, because they were enrolled in another research study involving WBTH, or because there was insufficient data available in the medical record
Our analysis suggests that infants treated with WBTH for moderate-to-severe HIE may have improved feeding tolerance, GI morbidity, and overall mortality compared with those not treated with WBTH

Summary

Introduction

Perinatal HIE is associated with high morbidity and mortality in the neonatal period as well as long-term neurocognitive deficits. Slightly different inclusion criteria were used among studies, multiple randomized controlled trials demonstrate that WBTH has a statistically significant improvement in neurodevelopmental disability at 18 to 24 months of [1,2,3] followup and 6 to 7 years of followup [4] for infants with moderate-to-severe HIE at birth. The effects of a perinatal hypoxic ischemic event extend beyond the brain and neurodevelopment. Decreased perfusion to the GI tract [5] and decreased motility leading to feeding intolerance [6] may follow perinatal asphyxia. Since WBTH acts to prevent secondary damage to the brain from ischemia and reperfusion injury that occurs following periods of perinatal anoxia, it is plausible to believe that WBTH could have similar preventative effects on the ischemic damage to the GI system

Methods

Results

Conclusion