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

The study used a novel classification of HIE based on aEEG and cooling status, limiting comparison with traditional severity classifications. A significant portion of data was collected retrospectively, leading to missing information and potential under-reporting of feeding difficulties due to limited SLT staffing. The sample size was small (n=52) with unequal subgroups, particularly the group with severely abnormal aEEG who were not cooled (n=4). The NFAS has limitations in assessing the pharyngeal phase, and no instrumental evaluations (VFSS or FEES) were performed, which may have led to under-identification of pharyngeal dysphagia and silent aspiration. The study was conducted at a single referral center in South Africa, which may limit generalizability to other settings with different access to therapeutic hypothermia.

The authors declared no conflicts of interest. The study was part of a postgraduate research project by the first author. Ethics approval was obtained from the University of Cape Town.

Do not assume that bedside clinical signs alone are sufficient to rule out pharyngeal dysphagia or aspiration in neonates with HIE. The study lacked instrumental assessment, and the authors note that pharyngeal difficulties were likely under-identified. Additionally, the finding that therapeutic hypothermia appeared to mitigate feeding difficulties is based on a small observational cohort and should not be interpreted as causal evidence for the efficacy of cooling in isolation.