Abdominal Complications Research Articles

P399 C-Reactive Protein Values After Surgery for Inflammatory Bowel Disease: Is It Still A Good Marker For Intra-Abdominal Complication? A Retrospective Cohort Study of, 347 procedures

Abstract Background C-reactive protein (CRP) is a useful predictive test to early detect abdominal complication after colorectal surgery. Inflammatory bowel disease (IBD) is responsible of chronic inflammation and abnormal basal CRP that could influence the interest of its management after abdominal surgery. The aim of this study was to evaluate CRP as an indicator of postoperative complication in a specific IBD population. Methods Retrospective study of patients undergoing ileocolic resection or ileal pouch-anal anastomosis for IBD between, 2012 and 2019. Intra-abdominal complication was defined as any intra-abdominal event, infectious or otherwise, occurring during the immediate postoperative period. The early postoperative period was defined as post-operative days (POD), 1 and, 2 and late postoperative period as POD, 3 and 4. Results Ileocolic resection represented, 242 patients and ileal pouch-anal anastomosis, 105 patients. Intra-abdominal complications occured in, 18.1% of patients (ICR=40, 16.5% and IPAA=23, 21.9%). Pre-operative CRP (48 hours before surgery) was available for, 96 patients (29.8%). Among them, 64 had an abnormal CRP value (median:, 13±45.4). No relation was found between a preoperative abnormal CRP value and post-operative intra-abdominal complications. CRP was significantly higher at an early (105.2±56.0 vs, 128.1±69.8; p=0.008) and late stage (112.9±72.8 vs, 185.3±111.5; p <, 0.0001) for patients having an intra-abdominal complication. The best sensitivity and specificity values were obtained at POD, 3–4 with a CRP cut-off of, 75 with an area under the curve of, 0.71. The ability to rule out an intra-abdominal complication with a CRP Value <75 mg/L was good with, at POD, 1–2 NPV=86.4% and PPV=19.9% and, at POD, 3 an NPV=90.3% and PPV=22.2%. A BMI >25kg/m2 (p=0.04) and an open surgical approach (p=0.009) were associated with higher CRP levels in the first POD. In multivariate analysis, pre-operative steroid use (p=0.03), CRP at POD, 3 >, 100mg/L (p=0.002) and a rise between CRP values more than, 50 mg/L (p=0.005) or, 100 mg/L (p <, 0.0001) at, 48 hours were significantly associated with intra-abdominal complication. A CRP at POD, 1 <75mg/L was associated with a lower rate of intra-abdominal complication (p=0.01). A score using these, 4 independent factors was created and showed significant differences in intra-abdominal complication, anastomotic leakage and readmission rate. Conclusion CRP is a useful predictive marker to detect abdominal complication after surgery in IBD population. Measurement of CRP can help to reduce hospitalization stay and orientate towards complementary examinations.

Evisceration Secondary to Coughing in a Child Undergoing Ventriculoperitoneal Shunt Surgery

Abdominal complications related to ventriculoperitoneal shunting are an entity described in the literature. Among these is evisceration. In this article we present a case of evisceration in a 5-month-old child, six days after DVP placement. We will discuss the probable etiology and prevention of such a complication.

Features of infective native aortic aneurysms on computed tomography

BackgroundInfective native aortic aneurysm (INAA) is a rare clinical diagnosis. The purpose of this study was to describe the CT findings of INAAs in detail.MethodsThis was a retrospective single-center study of INAA patients at a major referral hospital between 2005 and 2020. All images were reviewed according to a protocol consisting of aneurysm features, periaortic findings, and associated surrounding structures.ResultsOne hundred and fourteen patients (mean age, 66 years [standard deviation, 11 years]; 91 men) with 132 aneurysms were included. The most common locations were infrarenal (50.8%), aortoiliac (15.2%), and juxtarenal (12.9%). The mean transaxial diameter was 6.2 cm. Most INAAs were saccular (87.9%) and multilobulated (91.7%). Calcified aortic plaque was present in 93.2% and within the aneurysm in 51.5%. INAA instability was classified as contained rupture (27.3%), impending rupture (26.5%), and free rupture (3.8%). Rapid expansion was demonstrated in 13 of 14 (92.9%) aneurysms with sequential CT studies. Periaortic inflammation was demonstrated as periaortic enhancement (94.7%), fat stranding (93.9%), soft-tissue mass (92.4%), and lymphadenopathy (62.1%). Surrounding involvement included psoas muscle (17.8%), spondylitis (11.4%), and perinephric region (2.8%). Twelve patients demonstrated thoracic and abdominal INAA complications: fistulas to the esophagus (20%), bronchus (16%), bowel (1.9%), and inferior vena cava (IVC) (0.9%).ConclusionThe most common CT features of INAA were saccular aneurysm, multilobulation, and calcified plaques. The most frequent periaortic findings were enhancement, fat stranding, and soft-tissue mass. Surrounding involvement, including psoas muscle, IVC, gastrointestinal tract, and bronchi, was infrequent but may develop as critical INAA complications.

A core outcome set for damage control laparotomy via modified Delphi method

ObjectivesDamage control laparotomy (DCL) remains an important tool in the trauma surgeon’s armamentarium. Inconsistency in reporting standards have hindered careful scrutiny of DCL outcomes. We sought to develop a core...

Postoperative Enterocutaneous Fistula: A Severe and Desperate Complication in a Disadvantaged Surgical Setting

Purpose: Digestive or gastrointestinal fistula is one of the most feared postoperative complication along with dehiscence and infection. The aim of this study was to determine the etiological, clinical and therapeutic aspects of enterocutaneous fistulas in a disadvantaged surgical setting. Methods: This was a retrospective study covering a period of three years (January 2018 to December 2020) including records of patients managed for postoperative enterocutaneous fistula in the general surgery department of the Ignace DEEN national hospital in Conakry (Guinea). Results: During the three years of study, we compiled 69 records of patients with postoperative enterocutaneous fistulas, representing 14.68% of all postoperative abdominal complications registered in the department (n=468). The mean age of the patients was 29.61±17.32 years. In this series, 53 patients (76.81%) were initially operated in private health facilities and then referred to our department after the occurrence of the fistula. The most frequent indications for initial surgery were typhoid ileal perforation (37.68%) followed by appendicitis (26.09%) and sigmoid colon volvulus (15.94%). Spontaneous closure of the fistula was obtained in 41 patients (59.42%) with a mean time of 23 days. We noted 18 deaths (26.09%). Conclusion: Postoperative enterocutaneous fistula is a severe complication whose management in our environment is difficult and desperate for both patient and surgeon.

Incisional Hernia Occurring after Ventriculoperitoneal Shunt Fixation

Ventriculo-peritoneal shunt is the procedure of choice for hydrocephalus. Various complications of ventriculoperitoneal shunts were reported. Abdominal complications involving the distal tip of the catheter make the majority of the complications. In this case report we present a case of incisional hernia occurring in a patient who underwent fixation of ventriculoperitoneal shunt followed by revision of the shunt after a while

Antibiotic Prophylaxis for Surgical Site Infection in General Surgery: Oncological Treatments and HIPEC.

The procedure of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. Antibiotic prophylaxis is usually center-related and should be discussed together with the infectious disease specialist, taking into account the advanced oncologic condition of the patient, the complexity of surgery—often requiring multiorgan resections—and the risk of post-HIPEC neutropenia. The incidence of surgical site infection (SSI) after CRS and HIPEC ranges between 11 and 46%. These patients are also at high risk of postoperative abdominal infections and septic complications, and a bacterial translocation during HIPEC has been hypothesized. Many authors have proposed aggressive screening protocols and a high intra and postoperative alert, in order to minimize and promptly identify all possible infectious complications following CRS and HIPEC.

Surgical tactics for acute abdominal complications of primary hyperparathyroidism. Clinical case

Primary hyperparathyroidism (PH) is one of the most common diseases of the endocrine system that requires surgical treatment. The most common cause of PH is parathyroid adenoma, which occurs in 8590% of cases, in 510% multiple adenomas or hyperplasia of several or all parathyroid glands. Surgical treatment is the only radical and effective method of treating PH, however, the variability of the anatomy of the parathyroid glands, the possibility of their ectopic location, as well as the close connection with the thyroid gland, in some cases, complicate the intraoperative verification of the parathyroid adenoma. All this can lead to inadequate volumes with parathyroidectomy. In this article, the presented clinical case demonstrates how the complexity of intraoperative verification of the parathyroid glands during parathyroidectomy led to intra-abdominal life-threatening complications acute duodenal ulcer with subsequent perforation and acute cholecystitis against the background of persistent hypercalcemia and perioperative stress. Also, on the example of this case, surgical tactics are demonstrated, taking into account the pathogenesis of abdominal complications.

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit.

The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.

COMPLICATIONS DE LA MALADIE DE CROHN : PLACE DU SCANNER ET FACTEURS PREDICTIFS

Objective: The aim of this work was to study the place of CT in the emergency management of abdominal complications of Crohn's disease (CD). Materials and Methods: This was a retrospective, descriptive and crosssectional study conducted over a period of 4 years (January 1, 2015 to December 31, 2018) on 125 patient records collected in the radiology department of the Mohammed Tahar Maamouri hospital in Nabeul, Tunisia. Were included all patients received in the emergency room for acute abdominal symptomatology on a CD terrain. We studied the CT aspects of digestive complications of CD but also the predictive factors for the occurrence of complications. Results: The CT aspects observed were: parietal thickening in 97.6% of the cases, intense and stratified parietal enhancement in 52% of the cases, mesenteric fat infiltration in 49.6% of the cases, mesenteric hyperemia in 45.6% of the cases, sclerolipomatosis in 64.8% of the cases and adenomegalia in 22.8% of the cases. The lesions were located in the terminal ileum in 35.8% of cases. The main complications were stenosis in 26.4% of cases, fistulas in 16.8% of cases and abscesses in 12.8% of cases. Other associated signs: sacroiliitis, lithiasis, pancreatitis. A correlation was established between the occurrence of abdominal complications and the absence of immunosuppressive treatment, the presence of abdominal pain, fever and occlusive syndrome. Conclusion: CT is an imaging technique that still keeps its indications in the efficient management of CD especially in the diagnosis of abdominal complications where it constitutes the examination of choice in emergency situations. Key words: Crohn's disease, abdominal CT, complications. abdominal symptomatology on a CD terrain. We studied the CT aspects of digestive complications of CD but also the predictive factors for the occurrence of complications. Results: The CT aspects observed were: parietal thickening in 97.6% of the cases, intense and stratified parietal enhancement in 52% of the cases, mesenteric fat infiltration in 49.6% of the cases, mesenteric hyperemia in 45.6% of the cases, sclerolipomatosis in 64.8% of the cases and adenomegalia in 22.8% of the cases. The lesions were located in the terminal ileum in 35.8% of cases. The main complications were stenosis in 26.4% of cases, fistulas in 16.8% of cases and abscesses in 12.8% of cases. Other associated signs: sacroiliitis, lithiasis, pancreatitis. A correlation was established between the occurrence of abdominal complications and the absence of immunosuppressive treatment, the presence of abdominal pain, fever and occlusive syndrome. Conclusion: CT is an imaging technique that still keeps its indications in the efficient management of CD especially in the diagnosis of abdominal complications where it constitutes the examination of choice in emergency situations. Key words: Crohn's disease, abdominal CT, complications.

Composite Inflammatory Indicators as Early Predictor of Intra-abdominal Infections after General Surgery.

ObjectiveTo identify rapid and accurate early diagnostic indicators for intra-abdominal infection (IAI) after general surgery.MethodsWe conducted a retrospective analysis of 3,810 general surgical patients in our hospital from August 2017 to July 2018. The predictive value of PCT, CRP, TNFα, and IL6 on postoperative days (PODs) 1 and 3 and composite indicators for complicated IAIs among surgical patients was clarified.ResultsThere were 271 patients in the infected group and 614 patients in the uninfected group using IAI diagnostic criteria in this study. CRP, PCT, TNFα, and IL6 in the infected group were significantly higher than the uninfected group on POD1 and POD3. In the infected group, the composition of the four indicators on POD1 (AUC 0.819) and POD3 (AUC 0.848) showed higher predictive efficiency than the individual indicators (AUC 0.670–0.805).ConclusionThe composite of CRP, PCT, TNFα, and IL6 can be used as a predictor of postoperative abdominal infectious complications with high sensitivity and specificity on POD1 and POD3, which can provide a basis for early diagnosis of postoperative abdominal infectious complications.

Lumbar interbody fusion using oblique (OLIF) and lateral (LLIF) approaches for degenerative spine disorders: a meta-analysis of the comparative studies.

Systematic review and meta-analysis. Historically, posterior approaches to the lumbar spine have allowed surgeons to manage degenerative conditions affecting the lumbar spine. However, spinal muscles injury, post-surgical vertebral instability, cerebrospinal fluid (CSF) leakage, and failed back surgery syndrome (FBSS) represent severe complications that may occur after these surgeries. Lumbar interbody fusion using anterior (ALIF), oblique (OLIF), or lateral (LLIF) approaches may represent valuable surgical alternatives, in case fusion is indicated on single or multiple levels. The present study is a systematic review, conducted according to the PRISMA statement, of comparative studies on OLIF, and LLIF for degenerative spine disorders, and a meta-analysis of their clinical-radiological outcomes and complications. After screening 1472 papers on PubMed, Scopus, and Cochrane Library, only 3 papers were included in the present study. 318 patients were included for data meta-analysis, 128 in OLIF group, and 190 in LLIF group. There were no significative differences in terms of surgical (intraoperative blood loss and surgical duration) and clinical (VAS-back, VAS-leg, and ODI scores) outcomes, or fusion rates at last follow-up (> 2years). Significantly higher rates of abdominal complications, system failure, and vascular injuries were recorded in the OLIF group. Conversely, postoperative neurological symptoms and psoas weakness were significatively more common in LLIF group. The meta-analysis suggests that OLIF and LLIF are both effective for lumbar degenerative disorders, although each of them presents specific complications and this should represent a relevant element in the surgical planning.

Robotic endoscopic cooperative surgery for colorectal tumors: a feasibility study (with video).

Laparoscopic endoscopic cooperative colorectal surgery (LECS-CR) is a promising technique to achieve full-thickness resection of colorectal tumors. This approach has shown good rates of complete resection and low local recurrence, especially for large laterally spreading tumors, which are difficult to remove via endoscopy alone. However, it is often difficult to prevent peritoneal leakage of intestinal content, causing infections and risks of cancer spreading. It was hypothesized that a robotic assistance could make the procedure easier and decrease intestinal fluid leakage. This preclinical trial aims to assess the feasibility of robotic and endoscopic cooperative colorectal surgery (RECS-CR). LECS-CR was performed in five female pigs and RECS-CR was also performed in five female pigs. With the animal under general anesthesia, pseudotumors were created on the colonic mucosa at a distance comprised between 20 and 25cm from the anal verge. Desired resection margins were marked endoscopically and two stay sutures were placed either robotically or laparoscopically. A mucosa-to-submucosa dissection was performed endoscopically along the markings. Complete full-thickness dissection was performed cooperatively. The specimen was withdrawn endoscopically. The colon was closed using a self-fixating running suture. Abdominal contaminations, operating times, complications, and complete resections were evaluated and compared between LECS-CR and RECS-CR. The mean number of colonies of Escherichia coli in the RECS group was significantly lower than in the LECS group (36.7 ± 30.2 vs. 142.2 ± 78.4, respectively, p < 0.05). Operating time was comparable (118 ± 11.2 vs. 98.6 ± 25.7, respectively, p = 0.22). Two stenoses occurred in the LECS group. R0 resection was achieved in all cases. This study suggests that RECS-CR is feasible and has the potential to reduce intestinal content leakage, potentially preventing postoperative infections.

Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia.

Obesity is associated with poor outcomes in childhood acute lymphoblastic leukaemia (ALL). We explored whether severe treatment-related toxicity and treatment delays could explain this observation. This study included 1 443 children aged 2·0-17·9 years with ALL treated with the Nordic Society of Pediatric Haematology and Oncology (NOPHO) ALL2008 non-high-risk protocol. Prospective treatment-related toxicities registered every three-month interval were used. Patients were classified according to sex- and age-adjusted international childhood cut-off values, corresponding to adult body mass index: underweight, <17 kg/m2 ; healthy weight, 17 to <25 kg/m2 ; overweight, 25 to <30 kg/m2 ; and obese, ≥30 kg/m2 . Obese children had a higher incidence rate ratio (IRR) for severe toxic events {IRR: 1·55 [95% confidence interval (CI) 1·07-2·50]}, liver and kidney failures, bleeding, abdominal complication, suspected unexpected severe adverse reactions and hyperlipidaemia compared with healthy-weight children. Obese children aged ≥10 years had increased IRRs for asparaginase-related toxicities compared with healthy-weight older children: thromboses [IRR 2·87 (95% CI 1·00-8·21)] and anaphylactic reactions [IRR 7·95 (95% CI 2·15-29·37)] as well as higher risk for truncation of asparaginase [IRR 3·54 (95% CI 1·67-7·50)]. The high prevalence of toxicity and a higher risk of truncation of asparaginase may play a role in the poor prognosis of obese children aged ≥10 years with ALL.

The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction.

Reinforcement of the abdominal wall with synthetic mesh in autologous breast reconstruction using abdominal free tissue transfer decreases the risk of bulging and herniation. However, the impact of the plane of mesh placement on donor site complications has not yet been investigated. We performed a retrospective analysis of 312 patients who had undergone autologous breast reconstruction with muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps or deep inferior epigastric perforator (DIEP) flaps as well as polypropylene mesh implantation at the donor site. Donor site complications were compared among patients with different flap types and different mesh positions including overlay (n = 90), inlay and overlay (I-O; n = 134), and sublay (n = 88). Abdominal hernias occurred in 2.86% of patients who had undergone MS-TRAM reconstructions and in 2.63% of patients who had undergone DIEP reconstructions. When comparing patients with different mesh positions, donor site complications occurred in 14.4% of patients with overlay mesh, 13.4% of patients with I-O mesh, and 10.2% of patients with sublay mesh (P = 0.68). Abdominal hernias occurred in 4.44% of patients with overlay mesh, 2.24% of patients with I-O mesh, and 2.27% of patients with sublay mesh (P = 0.69). Multivariable logistic regression analysis did not identify a significant association between mesh position and hernia rates as well as wound complications. Our data indicate that the plane of synthetic mesh placement in relation to the rectus abdominis muscle does not impact the rate of postoperative donor site complications in patients undergoing breast reconstruction with MS-TRAM or DIEP flaps.

Abdominal complications due to collapse of a large mesenteric hematoma after rupture of a right colic artery aneurysm: a case report

BackgroundNon-traumatic mesenteric hematomas are usually well controlled, with no resulting symptoms. Herein, we report a case in which collapse of a large mesenteric hematoma, after rupture of a right colic artery aneurysm, caused small bowel obstruction and rapid absorption of the hematoma contributed to cholestasis.Case presentationA-44-year-old man presented with a sudden onset of severe right lower abdominal pain. Computed tomography (CT) revealed rupture of a right colic artery aneurysm and intra-abdominal bleeding. After embolization of the right colic artery aneurysm, a large mesenteric hematoma remained. As the patient had no symptoms, we elected to pursue conservative treatment. However, on day 16 post-onset, he developed right lower abdominal pain. On CT imaging, partial collapse of the wall of the residual mesenteric hematoma was observed, with visible leakage from the hematoma into the abdominal cavity, resulting in small bowel obstruction and cholestasis. Symptoms did not improve with conservative treatment, and we proceeded to surgical treatment on day 32 after onset. Intra-operatively, adhesions between the small bowel and the abdominal wall were identified and caused the small bowel obstruction. We proceeded with removing these adhesions and as much of the hematoma as possible. Although the small bowel obstruction improved after surgery, cholecystitis developed, and percutaneous transhepatic gallbladder aspiration was performed on day 45. The patient was discharged on day 70.ConclusionsCollapse of a mesenteric hematoma can cause small bowel obstruction. Rapid absorption of the hematoma due to the collapse might contribute to cholestasis. A large abdominal hematoma might be a risk factor for failure of conservative treatment, and surgery might be required due to abdominal complications.

Abdominal wall complications after kidney transplantation: A clinical review.

IntroductionAbdominal wall complications are common after kidney transplantation, and although they have a minor impact on patient and graft survival, they increase the patient's morbidity and may have an impact on quality of life. Abdominal wall complications have an overall incidence of 7.7–21%.MethodsThis review will explore the natural history of abdominal wall complications in the kidney transplant setting, with a special focus on wound dehiscence and incisional herni, with a particular emphasis on risk factors, clinical characteristics, and treatment.ResultsMany patient‐related risk factors have been suggested, including older age, obesity, and smoking, but kidney transplant recipients have an additional risk related to the use of immunosuppression. Wound dehiscence usually does not require surgical intervention. However, for deep dehiscence involving the fascial layer with concomitant infection, surgical treatment and/or negative pressure wound therapy may be required.ConclusionsIncisional hernia (IH) may affect 1.1–18% of kidney transplant recipients. Most patients require surgical treatment, either open or laparoscopic. Mesh repair is considered the gold standard for the treatment of IH, since it is associated with a low rate of postoperative complications and an acceptable rate of recurrence. Biologic mesh could be an attractive alternative in patients with graft exposition or infection.

EP.TH.915An Audit of BAUS Guidelines and Complications of Suprapubic Catheter Insertion

Abstract Introduction The National Patient Safety Agency (NPSA) noted between September 2005 to June 2009, 259 incidents relating to suprapubic catheter (SPC) insertion were reported. 9 of these were bowel perforations. BAUS produced guidelines for SPC insertion which included recommending open or ultrasound guided insertion of SPCs in patients with previous lower abdominal surgery. The aim of this audit was to assess compliance with BAUS guidelines and complications following SPC insertion. Methods All patients who had a SPC inserted in theatre at this District General Hospital (DGH) between October 2012 to October 2019 were identified. Patient demographics, ASA grade, co-morbidities, previous abdominal surgery and complications were recorded. Results A total of 154 patients (59.1% male; 40.3% female) were identified. Mean age was 65 and mode ASA was 3. 21 (13.6%) of patients had previous lower abdominal surgery. Of these 2 (10%) had ultrasound guided insertion, 3 (14%) were open, 11 (52%) had cystoscopy guided insertion alone and for 5 (24%) the method was unknown. 4 (2.6%) of patients had a bowel injury following SPC insertion. Discussion At this DGH there was poor compliance with BAUS guidelines with a significant number of patients with lower abdominal surgery not having open or ultrasound guided insertion of SPC. 2.6% of patients had a bowel injury, however none of these had previous lower abdominal surgery. For these patients BAUS guidelines were adhered to, but bowel injury was not prevented. We therefore recommend the consideration of image guided insertion of SPCs in all patients where possible.

Closed-incision Negative Pressure Therapy Prevents Major Abdominal Donor Site Complications in Autologous Breast Reconstruction

Closed-incision Negative Pressure Therapy Prevents Major Abdominal Donor Site Complications in Autologous Breast Reconstruction

Fluid Supply and Feeding Practices in Cooled Asphyxiated Newborns.

Therapeutic hypothermia (TH) for 72 h is the standard treatment to reduce neurological deficits in term newborns with hypoxic-ischemic encephalopathy. There is a large variability regarding nutritional supply during TH treatment in asphyxiated newborns. We performed a retrospective multicentre study in four level I (highest level of care in Germany) NICUs, including 135 asphyxiated term newborns undergoing TH. We analyzed enteral and parenteral nutritional supply during and after TH. We correlated nutritional supply with risk factors for encephalopathy, pH, Sarnat score, mechanical ventilation, seizures, and sedation. A total of 120 of 135 neonates received enteral nutritional supply within the first 24 h, and the majority of children were fully enterally fed within the first 10 days. The grade of encephalopathy and mechanical ventilation had a significant influence on the amount of enteral fluids (p = 0.01), whereas the pH and appearance of seizures did not affect the amount of nutritional supply significantly. Furthermore, we did not observe any correlation between enteral intake and abdominal complications such as necrotizing enterocolitis. We observed a large variability of feeding regimes in the four participating NICUs. Early enteral feeding among newborns undergoing TH was performed in each NICU and was well tolerated without increased rates of complications.