P2C338: Feeding Outcomes of Neonatal Hypoxic-ischemic Encephalopathy

Background: Lack of oral feeds is a common morbidity associated with neonatal hypoxic-ischemic encephalopathy (HIE) and is a frequent reason for delayed discharge home from the Neonatal Intensive Care Unit. Feeding practices and outcomes in this population have not been well delineated.

Methods: This was a retrospective, single-center cohort study of infants diagnosed with HIE using the NICHD criteria who underwent cooling from January 2017 to June 2022. Medical records were reviewed to abstract birth and delivery data, MRI results to assess presence and severity of brain injury and details of enteral feedings. At our center, infant feeding specialists who are occupational therapists assist infants with oral skill training. Charts were also reviewed to obtain follow-up data from clinics or emergency room visits on feeding-related complications and growth. Statistical analysis included chi square test and ANOVA with posthoc Bonferroni correction for comparison between groups; p < 0.05 was considered significant.

Results: Among 123 infants, 95 were orally fed at discharge, 11 were on nasogastric tube feedings, and 17 had G tubes. Table 1 is a comparison of birth and clinical characteristics of the three groups; compared with those who were orally fed, a greater proportion of infants who had G-tube feedings had intrapartum complications, Apgar scores less than 5 at 5 and 10 minutes, were more often diagnosed with severe HIE, had a longer hospital stay, seizures during and after cooling, prolonged respiratory support and intubated days, and delayed feeding start time. Of the 123 infants, 106 (86.2%) infants had some follow-up data. The median (range) age at latest follow-up was 131 (77.5-181.5) days for oral feeds, 78 (58-167) days for nasogastric feeds, and 180 (159.5-211.5) days for G-tube feeds. Figure 1 is a clustered bar graph showing longitudinal weight centiles in the three groups from birth to latest follow up; there were no significant differences.

Conclusion: Infants with HIE who underwent G-tube prior to discharge more often had severe HIE, prolonged respiratory support and delayed initiation of enteral feeds. Earlier identification of eventual G tube insertion may reduce duration of hospitalization. Longitudinal growth declined over time but was comparable across groups. These data may provide insights to guide practice improvement for enteral feedings in this vulnerable population.