{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:05:14Z","timestamp":1790147114902,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Medically administered nutrition and hydration (MANH) is a routine component of neonatal intensive care, yet it becomes ethically and emotionally complex when an infant's condition is recognised as life\u2010limiting and care is reoriented towards comfort. Decisions to continue, withhold, or withdraw MANH are challenging because feeding carries profound physiological, emotional, cultural, and relational meaning for families, while neonates cannot reliably communicate hunger, thirst, or discomfort. This commentary examines the ethical, clinical, and legal considerations surrounding MANH at the end of life in neonates and proposes a practical, individualised approach to decision\u2010making. Evidence specifically addressing MANH withdrawal in dying neonates remains limited, requiring clinicians to draw substantially on pediatric and adult palliative care literature. MANH should be regarded as a medical intervention guided by the infant's comfort, proportionality, goals of care, and best interests rather than an assumed moral obligation. Its potential benefits, including relief of hunger or thirst, preservation of parental caregiving roles, and cultural or spiritual significance, warrant explicit recognition. Comfort feeding should be considered where tolerated, with MANH continued when it provides meaningful benefit and reconsidered when it causes discomfort, imposes significant burdens, or prolongs dying without corresponding benefit. Australian and international legal frameworks broadly support withdrawal where MANH is non\u2010beneficial. Clear communication, shared decision\u2010making, cultural humility, multidisciplinary consensus, and regular reassessment are essential. Further prospective research is needed to better understand hunger, thirst, comfort, survival trajectories, and parental experiences following MANH withdrawal in dying neonates.<\/jats:p>","DOI":"10.1111\/jpc.70577","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:57:15Z","timestamp":1790146635000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutrition and Hydration Decisions in Neonatal Palliative Care"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6880-4107","authenticated-orcid":false,"given":"Amit","family":"Trivedi","sequence":"first","affiliation":[{"name":"Grace Centre for Newborn Intensive Care, the Children's Hospital at Westmead  Westmead New South Wales Australia"},{"name":"Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6828-1636","authenticated-orcid":false,"given":"Nadia","family":"Badawi","sequence":"additional","affiliation":[{"name":"Grace Centre for Newborn Intensive Care, the Children's Hospital at Westmead  Westmead New South Wales Australia"},{"name":"Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"},{"name":"Cerebral Palsy Alliance Research Institute, Allambie Heights  New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0539-9164","authenticated-orcid":false,"given":"Brian S.","family":"Carter","sequence":"additional","affiliation":[{"name":"Bioethics Centre, Children's Mercy\u2010Kansas City  Kansas City Missouri USA"},{"name":"Department of Medical Humanities and Bioethics The University of Missouri\u2010Kansas City School of Medicine  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7754-6296","authenticated-orcid":false,"given":"Ahmed","family":"Moustafa","sequence":"additional","affiliation":[{"name":"Grace Centre for Newborn Intensive Care, the Children's Hospital at Westmead  Westmead New South Wales Australia"},{"name":"Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4331-1434","authenticated-orcid":false,"given":"Anne","family":"Preisz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Sydney Health Ethics The University of Sydney  Sydney New South Wales Australia"},{"name":"School of Medicine University of Notre Dame  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-54161-3_63"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2016.02.006"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-1299"},{"issue":"6","key":"e_1_2_12_5_1","first-page":"683","article-title":"Why Physicians Must Not Give Food and Water to Every Patient","volume":"29","author":"Yarborough M.","year":"1989","journal-title":"Journal of Family Practice"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2021-323500"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1054\/clnu.2001.0416"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2018-001729"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.5867\/medwave.2018.01.7149"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2017.23.2.74"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/fetalneonatal-2012-301658"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308425"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-021-01011-y"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2022.12.008"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-1916"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-1905"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2003.10.007"},{"key":"e_1_2_12_18_1","unstructured":"P. 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