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Original article
Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy
  1. Beth Hazeldine1,
  2. Balamurugan Thyagarajan1,2,
  3. Michellee Grant1,
  4. Elavazhagan Chakkarapani1,2
  1. 1 St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2 School of Clinical Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Elavazhagan Chakkarapani; Ela.Chakkarapani{at}


Objective To evaluate current nutritional practices during and after therapeutic hypothermia (TH) for infants with hypoxic-ischaemic encephalopathy (HIE) in UK neonatal units.

Study design Email survey of neonatal clinicians.

Setting UK neonatal units providing active TH.

Patients Neonates cooled for HIE.

Methods Email survey including questions regarding the timing of starting enteral feeds, volumes, frequency and parenteral nutrition (PN) use and availability of guidelines.

Results Forty-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.

Conclusions Many 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.

  • perinatal asphyxia
  • therapeutic hypothermia
  • enteral feeding
  • breast milk
  • nutrition

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  • Contributors BH, BT and EC were involved in study design, questionnaire development, data analysis and literature review. BH and MG were involved in questionnaire development and data collection. BH prepared first version of the manuscript. BT and EC further developed the manuscript. All authors reviewed and approved the final draft.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement None.

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