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Am J Perinatol 2022; 39(15): 1678-1681
DOI: 10.1055/s-0041-1725161
Original Article

Electroencephalogram Background Predicts Time to Full Oral Feedings in Hypoxic–Ischemic Encephalopathy

Mrinmayee Takle
1   Children's National Hospital Child Neurology Residency Program, Washington, District of Columbia
,
Mark Conaway
2   Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
,
Jennifer Burnsed 
3   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
4   Department of Neurology, University of Virginia, Charlottesville, Virginia
› Author Affiliations Funding None.
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Abstract

Objective Infants with a history of neonatal hypoxic-ischemic encephalopathy (HIE) are at risk for oral motor dysfunction. Previous studies have associated the need for gastrostomy tube at neonatal intensive care unit discharge with brainstem injury on magnetic resonance imaging (MRI). However, the factors associated with time to full oral feeds in this population have not been previously described. This study aimed to study factors associated with time to full oral feeds in this population.

Study Design This is a single-center, retrospective study that examined these factors using Cox regression.

Results A total of 150 infants who received therapeutic hypothermia from 2011 to 2017 were included in this study. The single clinical factor significantly associated with time to full oral feeds was the severity of background abnormality on electroencephalogram in the first 24 hours of age (severe vs. mild 95% confidence interval [CI]: 0.34–0.74; moderate vs. mild 95% CI: 0.19–0.45). Brainstem injury on MRI was the factor most highly associated with need for gastrostomy tube placement (p = 0.028), though the overall incidence of need for gastrostomy tube feeds in this population was low (5%).

Conclusion These findings may help clinicians counsel families on what to expect in neonates with HIE and make decisions on the need for and timing to pursue gastrostomy tube in this population.

Key Points

  • The overall incidence of the need for assisted feeding at NICU discharge is low in this population.

  • MRI brainstem injury was most highly associated with need for gastrostomy tube placement.

  • Worsening severity of background abnormality on EEG was associated with longer time to oral feeds.

Keywords

neonate - hypoxia–ischemia - hypoxic–ischemic encephalopathy - oral feeding


Publication History

Received: 17 July 2020

Accepted: 25 January 2021

Article published online:
03 March 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Azzopardi D, Strohm B, Edwards AD. et al; Steering Group and TOBY Cooling Register participants. Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is managed in the UK outside a clinical trial. Arch Dis Child Fetal Neonatal Ed 2009; 94 (04) F260-F264
    CrossrefPubMedGoogle Scholar
  • 2 Quattrocchi CC, Longo D, Delfino LN. et al. Dorsal brain stem syndrome: MR imaging location of brain stem tegmental lesions in neonates with oral motor dysfunction. AJNR Am J Neuroradiol 2010; 31 (08) 1438-1442
    CrossrefPubMedGoogle Scholar
  • 3 Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ. et al. Feeding and communication impairments in infants with central grey matter lesions following perinatal hypoxic-ischaemic injury. Eur J Paediatr Neurol 2012; 16 (06) 688-696
    CrossrefPubMedGoogle Scholar
  • 4 Sarkar S, Bhagat I, Bapuraj JR, Dechert RE, Donn SM. Does clinical status 1 week after therapeutic hypothermia predict brain MRI abnormalities?. J Perinatol 2013; 33 (07) 538-542
    CrossrefPubMedGoogle Scholar
  • 5 Gupta S, Bapuraj JR, Carlson G, Trumpower E, Dechert RE, Sarkar S. Predicting the need for home gavage or g-tube feeds in asphyxiated neonates treated with therapeutic hypothermia. J Perinatol 2018; 38 (06) 728-733
    CrossrefPubMedGoogle Scholar
  • 6 Zanelli SA, Naylor M, Dobbins N. et al. Implementation of a ‘Hypothermia for HIE’ program: 2-year experience in a single NICU. J Perinatol 2008; 28 (03) 171-175
    CrossrefPubMedGoogle Scholar
  • 7 Quattrocchi CC, Fariello G, Longo D. Brainstem tegmental lesions in neonates with hypoxic-ischemic encephalopathy: magnetic resonance diagnosis and clinical outcome. World J Radiol 2016; 8 (02) 117-123
    CrossrefPubMedGoogle Scholar
  • 8 Shankaran S, Laptook AR, Ehrenkranz RA. et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15) 1574-1584
    CrossrefPubMedGoogle Scholar
  • 9 Azzopardi D, Brocklehurst P, Edwards D. et al; TOBY Study Group. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008; 8: 17
    CrossrefPubMedGoogle Scholar
  • 10 Jacobs SE, Morley CJ, Inder TE. et al; Infant Cooling Evaluation Collaboration. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165 (08) 692-700
    CrossrefPubMedGoogle Scholar