Neonatal Hypothermia

A Method to Provide Neuroprotection After Hypoxic Ischemic Encephalopathy

Katherine M. Newnam, MS, RN, CPNP, NNP-BC; Donna L. DeLoach, MS, RN, CPNP, NNP-BC

Disclosures

NAINR. 2011;11(3):113-124. 

In This Article

Nutritional Support

Initial fluid and electrolyte supports are directed toward the establishment of appropriate hydration and normoglycemia. Fluid restriction is initially indicted to reduce the incidence of cerebral edema as well as the likelihood of renal system insult. Total parenteral nutrition will be needed to optimize nutrition and preserve nitrogen balance through established central venous access.[4] Enteral feedings are often delayed secondary to concerns surrounding hypoxic injury to the gastrointestinal tract. It would also be assumed that therapeutic hypothermia would compromise the infant's ability to tolerate enteral feedings.

Once the infant has moved into the recovery phase, enteral feeding should be considered. A slow recovery may be the result of delayed clearance of sedation or anticonvulsants as well as lingering symptoms from the initial neurologic insult. One should not expect the infant with HIE to recover rapidly in spite of hypothermia intervention and rewarming. Even infants who ultimately do well will need some time to adequately "wake up."[32] Infants who exhibit early feeding difficulties and hypotonia may require tube feedings to support enteral nutritional advancement. Long-term gastrostromy tubes may be necessary for the most significantly compromised infants after HIE.[40]

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