THE RELATIONSHIP BETWEEN PROLONGED MECHANICAL VENTILATION AND DELAYED FEEDING MILESTONES IN NEWBORNS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY
1Tarsus University, Speech and Language Therapy, Mersin, Türkiye2İstanbul Medipol University, Speech and Language Therapy, İstanbul, Türkiye Background: Hypoxic–ischemic encephalopathy (HIE) disrupts the central coordination of sucking, swallowing, and respiration, predisposing newborns to feeding difficulties. Infants with HIE often require mechanical ventilation because of neurological instability, which may further delay oral feeding. This study investigated the association between mechanical ventilation duration and feeding milestones, breastfeeding transition, and early feeding skills in newborns with HIE.
Methods: This retrospective cohort study included 102 newborns with HIE who received therapeutic hypothermia in a neonatal intensive care unit. Outcomes included postnatal day of first oral feeding (POfirst), achievement of oral feeding for at least half of daily feeds (POhalf), achievement of full oral feeding (POFull), transition to breastfeeding, length of hospital stay, and Early Feeding Skills (EFS) scores at POfirst and discharge. Associations with ventilation duration were examined, infants were compared by ventilation duration (<7 vs. ≥7 days), and multiple linear regression analyses were performed after adjustment for HIE stage, gestational age, birth weight, convulsion status, and MRI findings.
Results: Longer mechanical ventilation duration was associated with delayed feeding milestones, later transition to breastfeeding, prolonged hospitalization, and lower EFS scores at POfirst and discharge. In adjusted regression models, mechanical ventilation duration remained significantly associated with later POfirst, POhalf, POFull, transition to breastfeeding, longer hospital stay, and lower EFS scores after adjustment for HIE stage, gestational age, birth weight, convulsion status, and MRI findings. Infants ventilated for ≥7 days showed significantly later feeding milestones and lower EFS scores than those ventilated for <7 days, while weight outcomes did not differ between groups.
Conclusions: In newborns with HIE treated with therapeutic hypothermia, prolonged mechanical ventilation was associated with delayed oral feeding and breastfeeding transitions and lower early feeding skill scores. These findings should not be interpreted as evidence of a causal effect of ventilation alone, because ventilation duration may also reflect underlying encephalopathy severity and overall illness burden. Nevertheless, ventilation duration may serve as a practical clinical marker for identifying infants who require closer feeding surveillance and early multidisciplinary support.
Keywords : hypoxic–ischemic encephalopathy, mechanical ventilation, oral feeding, breastfeeding, early feeding skills