114 - Implementing a Feeding Protocol During Therapeutic Hypothermia for Neonates with Hypoxic-Ischemic Encephalopathy: A Quality Improvement Initiative

Publication Number: 4112.114

Laila Wazneh, Montreal Children's Hospital, McGill University Health Center, Montreal, PQ, Canada; Caroline Porraccio, McGill University Health Center, Montreal, PQ, Canada; Christine Labelle, CUSM, Montreal, PQ, Canada; Jarred Garfinkle, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Pia Wintermark, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada

Background: Feeding neonates with hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH) has traditionally been avoided due to concerns about feeding intolerance and necrotizing enterocolitis (NEC). However, emerging evidence suggests that minimal enteral feeding during TH in stable neonates with HIE is safe and may be both safe and beneficial. Until March 2023, our centre did not initiate feed during TH.

Objective: To implement and evaluate a structured feeding protocol for neonates with HIE during TH, aiming to safely introduce enteral feeds, reduce sedation use, and shorten time to full enteral feeds (FEF) and length of stay (LOS).

Design/Methods: We performed a before–after quality improvement study of term and near-term neonates with HIE treated with TH over two 12-month periods: pre-period (Jan–Dec 2022, n=33) and post-period (Sep 2023–Aug 2024, n=38). Eligibility for feeding required respiratory, cardiovascular, and neurological stability. Outcomes included proportion fed during TH, time to FEF, sedation use and duration, LOS, and feeding complications.

Results: Following implementation, 68% (26/38) were fed during TH compared with none in the pre-period. Time to FEF decreased significantly (5.84 vs 7.00 days, p=0.004). Sedation was initiated earlier in the post-period (p=0.018) but discontinued sooner (day 2 vs. day 4, p=0.013). NICU length of stay and hospital stay did not differ.
Within the post-period, despite having comparable 10-minute Apgar score, cord pH and first gas pH, fed neonates achieved FEF earlier (4.8 vs 8.1 days, p=0.0001), and had shorter NICU (7 vs 14 days, p=0.0082) and hospital stays (7.8 vs 21.6 days, p=0.0086) than non-fed neonates. Sedation was also discontinued sooner in the fed group (p=0.033). No NEC or major complications were observed.

Conclusion(s): Feeding during TH in carefully selected neonates with HIE was feasible, safe, and associated with earlier feeding milestones and sooner cessation of sedation. Strict eligibility criteria supported safe implementation.