When a newborn’s brain is injured from lack of oxygen, doctors often cool the body to protect it. A question has been whether starting feeds during cooling is safe. In 94 newborns with moderate to severe brain injury who received cooling, doctors compared early feeding during cooling versus delayed feeding after cooling. The main worry was gut problems. After adjusting for other medical factors, early feeding was not tied to more gut problems than delayed feeding. Early feeding was also linked to starting feeds sooner, shorter time on IV nutrition, and lower hospital costs. This was a single-center retrospective study, so the results show links, not proof that early feeding causes these benefits. Unmeasured factors could still influence the findings, and the study can’t say whether early feeding improves long-term brain outcomes. Still, it offers reassurance that, in this setting, early feeding during cooling may be safe and is associated with practical benefits.
Early enteral feeding during hypothermia for neonatal HIE shows no GI adverse event linkEarly feeding during baby cooling therapy appears safe
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Key Takeaway
Consider that early enteral feeding during hypothermia for neonatal HIE was not linked to GI adverse events in this observational study.
This retrospective cohort study at a single Chinese hospital included 94 consecutive neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia. The intervention was early enteral feeding (EEF) initiated during hypothermia or rewarming (n=48), compared to delayed enteral feeding (DEF) initiated post-rewarming (n=46).
The primary outcome was gastrointestinal adverse events (GIAEs). After adjustment for confounders, EEF was not independently associated with GIAEs (OR = 0.75, 95% CI: 0.23–2.44, P = 0.636). Secondary outcomes showed EEF was associated with reduced time to feeding initiation, shorter parenteral nutrition duration, and lower hospitalization costs (all P < 0.05).
Safety was assessed via GIAEs, with no significant difference between groups after adjustment. Serious adverse events, discontinuations, and tolerability were not reported.
Key limitations include the single-center retrospective design, potential confounding by indication, and small sample size. The study highlights the challenge of confounding in interpreting feeding timing associations.
Practice relevance is restrained; findings are observational and do not imply causation. Clinicians should consider these associations cautiously in this specific population.
What this means for you:
In 94 cooled newborns, early feeding wasn’t linked to more gut problems and was tied to faster feeding starts and lower costs. View Original Abstract ↓
ObjectiveTo analyze real-world feeding decisions in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH), assess potential confounding by indication, and clarify how this bias may affect the interpretation of the association between feeding timing and clinical outcomes.MethodsWe conducted a single-center retrospective cohort study involving 94 consecutive neonates with moderate to severe HIE who received standardized TH at the Children's Hospital of Chongqing Medical University from March 2024 to March 2025. These neonates were assigned to either the early enteral feeding (EEF) group (initiated during TH/rewarming, n = 48) or the delayed enteral feeding (DEF) group (initiated post-TH/rewarming, n = 46). The primary outcome was gastrointestinal adverse events (GIAEs). We used multivariate logistic regression to adjust for confounders and performed subgroup analyses to explore feeding safety across different disease severity levels.ResultsThe DEF group had significantly higher rates of invasive ventilation (28.3% vs. 6.3%), hemodynamic support (82.6% vs. 29.2%), and peripherally inserted central catheter (PICC) placement (50.0% vs. 14.6%) (all P 0.999). After adjustment, EEF was not independently associated with GIAEs (OR = 0.75, 95% CI: 0.23–2.44, P = 0.636), but it shortened time to feeding initiation and parenteral nutrition duration, and reduced hospitalization costs (all P
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