Samaai, IlhaamPepper, Michael SeanPillay, ShaktiHorn, Alan R.2025-11-122025-11-122025-07-30Samaai, I., Pepper, M.S., Pillay, S. & Horn, A.R. (2025) Minimal impact of feed intolerance during therapeutic hypothermia for hypoxic ischaemic encephalopathy in a South African cohort with a standardised feeding regimen. Front. Pediatr. 13:1611619: 1-10. doi: 10.3389/fped.2025.1611619.2296-2360 (online)10.3389/fped.2025.1611619http://hdl.handle.net/2263/105255DATA AVAILABILITY STATEMENT : The datasets presented in this article are not readily available because informed consent was not taken for that type of data storage and access. However, access to the de-identified raw data set, for purposes of collaborative sub-studies with the authors, pending relevant ethics committee approval, can be obtained from the corresponding author. Requests to access the datasets should be directed toalan.horn@uct.ac.za. This article is part of the Research Topic : Evaluating Efficacy and Outcomes in Neonatal HIE Treatment: A Global PerspectiveINTRODUCTION : Enteral feeding during therapeutic hypothermia (TH) for neonatal hypoxic ischaemic encephalopathy (HIE), is beneficial, but there is insufficient evidence to guide timing and feed advancement strategies. The aim of this study was to describe feed tolerance and outcomes after TH with a standardized progressive early enteral feeding regimen. METHODS : Data were retrospectively reviewed from neonates with HIE who were treated with TH for HIE in the Groote Schuur Hospital (GSH) Neonatal intensive care unit (NICU), between 1 July 2019 and 31 October 2022. Enteral feeds were commenced at age 12–24 h and incremented daily if tolerated, at 12 ml/kg/day for the first 3 days and 24 ml/kg thereafter. Nutritional, morbidity and mortality outcomes were compared between neonates with and without early feed intolerance (EFI) by the fourth day of life. RESULTS : Thirty three percent (16/48) developed EFI. However, by day six the median (IQR) enteral volumes were, 120 (110–120) and 90 (90–99), in neonates without and with feed intolerance respectively. There were no differences in resuscitation characteristics. Neonates with EFI, had higher HIE grades, more amplitude integrated electro-encephalograph (aEEG) suppression at 48 h (p = 0.002), later attainment of full nutritive sucking or cup feeds (p < 0.001) and longer hospital stays (p = 0.038). There were no differences in other morbidities. Mortality was 6% and necrotising enterocolitis did not occur in either group. CONCLUSIONS : Early feeding was generally well tolerated. Feed intolerance was more frequent in neonates with severe HIE, but most neonates achieved independence from IV fluids by day six.en© 2025 Samaai, Pepper, Pillay and Horn. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).Therapeutic hypothermiaHypoxic ischaemic encephalopathy (HIE)NeonateHypoxia ischaemia-brainHypothermia-inducedAfrica south of the SaharaNeonatal encephalopathyNutrition-enteralArticle