A description of feeding and swallowing in neonates with hypoxic ischemic encephalopathy

Abstract

Background: Intrapartum-related complications, including intrapartum hypoxia and subsequent hypoxic ischemic encephalopathy (HIE), are the second leading cause of neonatal deaths in South Africa. Complications may be associated with a substantial burden of impairment, including dysphagia.
Objectives: To describe the feeding and swallowing profile of neonates with HIE in a neonatal unit in Cape Town, South Africa.
Method: A descriptive, exploratory, longitudinal study of 52 participants with varying severities of HIE is presented. Clinical feeding and swallowing assessments were conducted with 13 prospective participants using the Neonatal Feeding Assessment Scale, and medical folder reviews were conducted for 39 retrospective participants. Data were analysed using descriptive and inferential statistics.
Results: A median of 4 days (p = 0.036) to oral feeding readiness and 5 days (p = 0.016) to full oral feeds was observed. Participants with a severely abnormal initial amplitude-integrated electroencephalography who did not receive hypothermia treatment demonstrated significantly longer times for both outcomes. Participants across all severities presented with feeding and swallowing difficulties, primarily in the oral phase. Most participants (96.2%) were discharged on full oral feeds, while the remaining 3.8% were discharged on nasogastric tube feeds while awaiting gastrostomy placement.
Conclusion: Regardless of severity, neonates with HIE are at increased risk of feeding and swallowing difficulties. Thus, early identification and management before discharge from the neonatal unit, and long-term follow-up of infants with HIE, are recommended.
Contribution: This study contributes to the small body of research on feeding and swallowing difficulties in neonates with HIE and may guide future research.