Faculty Opinions recommendation of One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial.
This chapter provides a summary of the landmark study known as the EDEN trial. In patients with acute lung injury (ALI) and without malnutrition does trophic enteral feeding during the first 6 days of critical illness increase ventilator-free days (VFDs) and decrease gastrointestinal intolerance compared with full enteral feeding? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter then briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Introduction: Perinatal asphyxia is a common neonatal problem and contributes significantly to neonatal morbidity and mortality. Encephalopathy occurs in 50% to 60% of patients with severe perinatal asphyxia. Moderate hypoxic ischaemic encephalopathy (HIE), 10% to 20% die and 30% to 40% develop neurodeficits, whereas 50% of those with severe HIE die and almost all survivors develop neurodeficits. The systematic administration of magnesium sulphate (MgSO4) after perinatal asphyxia has shown effective resolution of neuronal injury. We have conducted this study to validate the effect of MgSO4 in severely asphyxiated neonates, so as to utilize its benefits on ameliorating the outcome associated with severe perinatal asphyxia/HIE.
Objective of the Study: To determine the characteristics and outcome of magnesium sulphate on neurological outcome in severe perinatal asphyxia
Materials and Methods: A prospective interventional study of magnesium sulphate treatment of neonates with severe perinatal asphyxia conducted over one year period from 1st August 2017 to 31st July 2018.
Results: Of the 52 neonates, male 34 while there 18 female giving a ratio of (M: F is 1:1.8). There were 30 (57.7%) in-born and 22 (42.3%) out-born, the total asphyxia cases (30/144) giving the incidence of 20.8% among in born. About one half (55.8%) of the patients commenced MgSO4 therapy at < 6 hours after birth, while 30.6% and 16.6% commenced MgSO4 therapy at 6 - < 24 hours and > 24 hours after birth respectively. About one half (49.0%) commenced enteral feeding within 5 – 7 days while 36.7% and 14.3% commenced enteral feeding at 4 < days and at > 7 days respectively. Majority of the patients commenced full enteral feeding at either between 5 – 7 days or > 7 days while only 36.7% of the neonates commenced full enteral feeding before 5 days. Equally, primary outcome, fully recovered and initiation breast feeding.
Conclusion: Of the fifty two patients managed, 5 (9.6%) died during the treatment period after 8th day of admission and at follow up, while 47 (90.4%) survived. Also greater 50% of the survivors commenced breast feeding within five days of admission and were clinical normal at follow up clinic. Whether this coincidental or a true effect of MgSo4, a future prospective randomized controlled trial may make the picture clearer
One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial