Feasibility of minimal enteral nutrition in neonates with perinatal asphyxia during therapeutic hypothermia: A randomized controlled trial.

Abstract

Background: Therapeutic Hypothermia (TH) is a standard of care for neonates with birth asphyxia with moderate to severe hypoxic-ischemic encephalopathy. Despite lack of evidence, it is common practice to withhold feeds during TH due to risk of NEC. As there are no prior Indian studies and in view of limited evidence, this study was aimed to assess the feasibility of minimal enteral nutrition in our cohort of asphyxiated neonates during TH. Methods: This study was conducted in the Level III a NICU of Shri BM Patil Medical College Hospital and Research Centre, Vijayapura. Design: Open-label, parallel grouped, randomized controlled trial. 100 asphyxiated neonates undergoing therapeutic hypothermia were enrolled. Eligible newborns were randomized to receive either minimal enteral feeding or no feeding (50 newborns in each group) during therapeutic hypothermia. Results: Both groups were comparable in maternal and neonatal characteristics. Among 100 cooled neonates, 50 cooled neonates were randomized to MEN group and 50 cooled neonates to Control group. No statistically significant differences were observed among complications associated with therapeutic hypothermia between MEN group and Control group. Indicators of Sepsis and NEC such as Leucopenia/Neutropenia/Thrombocytopenia were observed in both groups which was not statistically significant (p>0.05). MEN neonates had a reduced length of hospital stay (mean 9 ± 2 days vs. 14 ± 3 days, p<0.05), and time to reach full oral feeds (7 ± 2 days vs. 12 ± 3 days, p<0.05). Conclusion: Minimal enteral feeding for neonates with moderate or severe HIE receiving therapeutic hypothermia is safe and feasible and associated with decreased time to reach full enteral feeding and reduced NICU stay and is not associated with significant complications like NEC.