Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy
Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy
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DOI：
10.1136/bmjpo-2017-000022
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发表时间：
2017-07-01
影响因子：
2.6
通讯作者：
Chakkarapani, Elavazhagan
中科院分区：
文献类型：
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作者：
Hazeldine, Beth;Thyagarajan, Balamurugan;Chakkarapani, Elavazhagan
目的评估英国新生儿单位中缺氧缺血性脑病 (HIE) 婴儿治疗性低温 (TH) 期间和治疗后的当前营养实践。研究设计新生儿临床医生的电子邮件调查。设置提供主动 TH 的英国新生儿单位。患者为 HIE 进行冷却。方法电子邮件调查包括有关开始肠内喂养的时间、量、频率和肠外营养 (PN) 使用和指南的可用性的问题。结果四十九收到答复（49/69，71%）。 TH 期间和复温期间的肠内喂养率为 59% (29/49)。 TH 期间开始肠内喂养的单位比例增加存在显着的线性趋势 (p=0.001)。与 TH 后期相比，TH 期间开始的乳量显着降低（中位值（范围）：7.5 mL/kg/天 (1.5-24) vs 17.5 mL/kg/天 (7.5-30)，p=0.0004）。在 TH 期间，52% 的单位主要使用母乳，主要是每小时 2-3 次喂养，并且 55% 的单位根据耐受情况增加了奶量。只有 29% (14/49) 的单位使用 PN，其中 86% (12/14) 的单位在 PN 期间提供肠内喂养。 31% (15/49) 的单位提供了 TH 期间喂养指南。 结论 许多新生儿临床医生在 TH 期间主要使用挤出的母乳提供肠内喂养，无论是否有 PN，尽管差异很大。营养实践的异质性强调了评估 TH 期间肠内和肠外喂养安全性的必要性。
ObjectiveTo evaluate current nutritional practices during and after therapeutic hypothermia (TH) for infants with hypoxic-ischaemic encephalopathy (HIE) in UK neonatal units.Study designEmail survey of neonatal clinicians.SettingUK neonatal units providing active TH.PatientsNeonates cooled for HIE.MethodsEmail survey including questions regarding the timing of starting enteral feeds, volumes, frequency and parenteral nutrition (PN) use and availability of guidelines.ResultsForty-nine responses were received (49/69, 71%). The rate of enteral feeding during TH and rewarming was 59% (29/49). There was a significant linear trend for the increase in the proportion of units starting enteral feeds (p=0.001) during TH. As compared with post-TH period, significantly lower milk volumes were started during TH (median (range): 7.5 mL/kg/day (1.5-24) vs 17.5 mL/kg/day (7.5-30), p=0.0004). During TH, breast milk was primarily used by 52% of units predominantly as 2-3 hourly feeds, and volumes were increased as tolerated in 55% of units. Only 29% (14/49) of units used PN, with 86% (12/14) of those offering enteral feeds during PN. Guidelines for feeding during TH were available in 31% (15/49) of units.ConclusionsMany neonatal clinicians offer enteral feeds predominantly using expressed breast milk, with or without PN, during TH, although with huge variability. The heterogeneity in the nutritional practice underscores the need for assessing the safety of both enteral and parenteral feeding during TH.