Background: Therapeutic hypothermia (TH) is standard of care for neonates ≥36 weeks with hypoxic-ischemic encephalopathy (HIE). Although intravenous fluid restriction is common, optimal strategies for parenteral and enteral nutrition remain unclear. This study evaluated the tolerance of parenteral nutrition (PN) and enteral feeding in neonates undergoing TH, as well as the impact of these interventions on clinical outcomes.
Methods: We retrospectively reviewed charts from the Florida Neonatal Neurologic Network (FN3) of neonates who underwent TH for HIE between 2012 and 2020. Collected data included demographics, neurologic assessments, nutritional strategies, laboratory values, and MRI findings. Statistical analysis was performed using one-way ANOVA, with results expressed as Kruskal-Wallis p-values.
Results: Of 170 neonates, 163 met inclusion criteria. Participants were categorized by nutritional approach: intravenous fluids (IVF), PN, or both. Neonates receiving PN had significantly higher blood urea nitrogen (BUN) during TH (p < 0.05), although values remained within acceptable limits. Lipid tolerance did not differ between groups. PN administration was associated with improved glucose regulation at 12 h (p < 0.05). Enteral feeding correlated with reduced brain injury on MRI and improved neurodevelopmental outcomes, including cognitive (p < 0.05) and motor (p < 0.05) function. Neonates receiving both PN and enteral feeding demonstrated significant recovery from malnutrition by the first outpatient follow-up (p < 0.05) and achieved full enteral feeds sooner (p < 0.05).
Conclusions: Early nutritional support, including PN and enteral feeding, appears to be well-tolerated in neonates undergoing TH for HIE. These findings suggest that providing early nutrition may enhance neurodevelopmental outcomes and promote growth during TH.
Keywords: Hypoxic ischemic encephalopathy; encephalopathy; intravenous fluids; nutrition; parenteral nutrition.