Enteral feeding during therapeutic hypothermia for hypoxic-ischemic encephalopathy was feasible and gastrointestinal complications were uncommon, with infants fed during cooling achieving full enteral feeding earlier and having shorter hospital stays than those not fed during cooling.
Enteral feeding during therapeutic hypothermia was administered to the majority of included infants.
Infants who received enteral nutrition during therapeutic hypothermia achieved full enteral feeding significantly earlier than those not fed during cooling.
Infants who received enteral nutrition during therapeutic hypothermia had a shorter length of hospital stay.
Breastfeeding at discharge was more frequent among infants who received enteral nutrition during therapeutic hypothermia.
Despite inter-centre differences in feeding strategies, time to full enteral feeding was comparable between the Italian and Belgian centres.
Feeding intolerance and temporary feeding withdrawal occurred in a minority of infants.
Necrotizing enterocolitis (NEC) was rare and limited to mild disease, with no progression to advanced stages or surgery.
This research suggests that feeding newborns through a tube into their stomach or intestine (enteral feeding) while they are undergoing whole-body cooling treatment (therapeutic hypothermia) for oxygen deprivation at birth (hypoxic-ischemic encephalopathy, or HIE) is feasible and relatively safe. The study examined 276 surviving babies treated at hospitals in Italy and Belgium over more than a decade, and found that 60% received some enteral feeding during the cooling period. Babies who were fed during cooling reached full feeding levels about four days sooner, left the hospital four days earlier on average, and were more likely to be breastfed at discharge compared to babies who were not fed during cooling. Serious gut complications were uncommon. Only three babies (about 1%) developed necrotizing enterocolitis (NEC), a dangerous intestinal condition that is a major concern in fragile newborns, and none of these cases progressed to severe disease requiring surgery. Feeding intolerance—such as vomiting or delayed stomach emptying—occurred in about 17% of babies, and feeding had to be temporarily stopped in about 11%, but these were generally manageable issues. Notably, all three NEC cases occurred in babies with the most severe form of HIE (Sarnat stage III), raising the possibility that feeding risk may be concentrated in the sickest infants. This research suggests that cautious enteral feeding during therapeutic hypothermia is practical and may offer benefits, but the study's observational design means it cannot prove that feeding during cooling directly caused the better outcomes—sicker babies may have been less likely to be fed in the first place. The authors emphasize that the finding about NEC and disease severity is preliminary given the very small number of cases, and that prospective clinical trials are needed to determine the best timing and pace of feeding, particularly for the most severely affected newborns.
De Rose D, Bersani I, Salvatori G, Campi F, Martini L, Maddaloni C, et al.. (2026). Enteral Feeding During Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy in Neonates: A Multicentre Study from Italy and Belgium.. Nutrients. https://doi.org/10.3390/nu18193240