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Published on: June 11, 2020
Electroencephalogram Background Predicts Time to Full Oral Feedings in Hypoxic-Ischemic Encephalopathy
Mrinmayee Takle1, Mark Conaway2, Jennifer Burnsed3,4
1Children's National Hospital Child Neurology Residency Program, Washington, District of Columbia.
Insights
Infants with hypoxic-ischemic encephalopathy (HIE) who have severe EEG abnormalities may take longer to achieve full oral feeds. Brainstem injury on MRI is linked to gastrostomy tube need, though overall incidence is low.
Area of Science:
- Neonatal neurology
- Pediatric gastroenterology
- Neurodevelopmental disorders
Background:
- Infants with hypoxic-ischemic encephalopathy (HIE) are at risk for oral motor dysfunction.
- Previous studies link gastrostomy tube use at discharge to brainstem injury on MRI.
- Factors influencing time to full oral feeds in HIE infants remain understudied.
Purpose of the Study:
- To identify factors associated with the time to achieve full oral feeds in infants with HIE.
- To explore predictors of gastrostomy tube need in this population.
Main Methods:
- Single-center, retrospective study.
- Cox regression analysis.
- Included 150 infants who underwent therapeutic hypothermia (2011-2017).
Main Results:
- The severity of background abnormality on electroencephalogram (EEG) in the first 24 hours was significantly associated with time to full oral feeds.
- Severe EEG abnormality correlated with longer time to oral feeds compared to mild (95% CI: 0.34-0.74).
- Moderate EEG abnormality also correlated with longer time to oral feeds compared to mild (95% CI: 0.19-0.45).
- Brainstem injury on MRI was the factor most associated with the need for gastrostomy tube placement (p=0.028).
- The overall incidence of gastrostomy tube need was low (5%).
Conclusions:
- EEG background severity is a key factor predicting oral feeding progression in HIE infants.
- Clinicians can use these findings to counsel families regarding feeding expectations.
- These insights aid in decisions regarding the necessity and timing of gastrostomy tube placement.
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..
