663 - Increasing Enteral Feeding During Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 663
Publication Number: 663.139

Emily Lo, The Hospital for Sick Children, Toronto, ON, Canada; Caroline Ahearne, University Hospital Wales, Cardiff, Wales, United Kingdom; RANA MAHAJNAH, the hospital for sick children, Umm El Fahem, Hefa, Israel; Pei Sing Chan, The Hospital for Sick Children, Toronto, ON, Canada; Alessia Gallipoli, The Hospital for Sick Children, Toronto, ON, Canada; Diane Wilson, The Hospital for Sick Children, Newmarket, ON, Canada; Amr El Shahed, The Hospital for Sick Children, Toronto, ON, Canada; Kyong-Soon Lee, The Hospital for Sick Children, Toronto, ON, Canada

Presenting Author(s)

EL

Emily Lo, MD (she/her/hers)

Neonatology Fellow
The Hospital for Sick Children
Toronto, Ontario, Canada

Background:

Historically, enteral feeding during therapeutic hypothermia (TH) has been withheld due to concerns of gut hypoperfusion and potential association with necrotizing enterocolitis (NEC). Recently studies have demonstrated the safety of enteral feeding during TH and showed higher breastfeeding rates and shorter NICU length of stay.

Objective:

To increase day five enteral feeding volume by 10 mL/kg/day for eligible infants undergoing TH from September 2021 to June 2022 in the NICU in a large academic hospital.

Design/Methods: In this quality improvement (QI) project, we used the Plan-Do-Study-Act (PDSA) methodology, process mapping and fishbone analysis. We implemented interventions including the development of clinical practice guidelines to promote early enteral feeding during TH and teaching sessions with interprofessional groups.

Results: We evaluated 49 and 27 neonates pre- (Sept 2020-Aug 2021) and post-intervention (Sept 2021-June 2022), respectively. The process measure was time to first enteral feeds which decreased from 91.5 hours to 61.0 hours, pre and post respectively (p< 0.01) (Figure 1). The outcome measure was day five feed volumes, which was 24 mL/kg/day and 36 mL/kg/day, pre and post respectively (p=0.17) (Figure 2). Median length of NICU stay decreased from 6 days to 5 days (p< 0.01). The balancing measure was incidence of NEC, and no cases were diagnosed pre or post intervention.

Conclusion(s): Using QI methods, we increased early enteral feeding during TH without adverse effects on NEC. Key factors to success were the engagement of dietitians in the project team, who had a major role in reminding the team to start enteral feeding for eligible patients during daily ward rounds. Additional PDSA cycles to increase compliance with the feeding guideline are planned, including reminders using screen savers and parent handouts.