{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:11:31Z","timestamp":1785417091314,"version":"3.56.0"},"reference-count":51,"publisher":"AOSIS","issue":"2","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Intrapartum-related complications, including intrapartum hypoxia and subsequent hypoxic ischemic encephalopathy (HIE), are the second leading cause of neonatal deaths in South Africa. Complications may be associated with a substantial burden of impairment, including dysphagia.\nObjectives:\u00a0To describe the feeding and swallowing profile of neonates with HIE in a neonatal unit in Cape Town, South Africa.\nMethod:\u00a0A descriptive, exploratory, longitudinal study of 52 participants with varying severities of HIE is presented. Clinical feeding and swallowing assessments were conducted with 13 prospective participants using the Neonatal Feeding Assessment Scale, and medical folder reviews were conducted for 39 retrospective participants. Data were analysed using descriptive and inferential statistics.\nResults:\u00a0A median of 4 days (p\u00a0= 0.036) to oral feeding readiness and 5 days (p\u00a0= 0.016) to full oral feeds was observed. Participants with a severely abnormal initial amplitude-integrated electroencephalography who did not receive hypothermia treatment demonstrated significantly longer times for both outcomes. Participants across all severities presented with feeding and swallowing difficulties, primarily in the oral phase. Most participants (96.2%) were discharged on full oral feeds, while the remaining 3.8% were discharged on nasogastric tube feeds while awaiting gastrostomy placement.\nConclusion:\u00a0Regardless of severity, neonates with HIE are at increased risk of feeding and swallowing difficulties. Thus, early identification and management before discharge from the neonatal unit, and long-term follow-up of infants with HIE, are recommended.\nContribution:\u00a0This study contributes to the small body of research on feeding and swallowing difficulties in neonates with HIE and may guide future research.<\/jats:p>","DOI":"10.4102\/sajcd.v72i2.1121","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T07:40:56Z","timestamp":1759218056000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A description of feeding and swallowing in neonates with hypoxic ischemic encephalopathy"],"prefix":"10.4102","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5357-3422","authenticated-orcid":false,"given":"Samantha","family":"Branfield","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9194-5522","authenticated-orcid":false,"given":"Natasha R.","family":"Rhoda","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2537-8241","authenticated-orcid":false,"given":"Janine","family":"Joemat","sequence":"additional","affiliation":[{"name":"Mowbray Maternity Hospital, Department of Health and Wellness, Western Cape Government, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6480-513X","authenticated-orcid":false,"given":"Vivienne","family":"Norman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Acun, C., Karnati, S., Padiyar, S., Puthuraya, S., Aly, H., & Mohamed, M. (2022). Trends of neonatal hypoxic-ischemic encephalopathy prevalence and associated risk factors in the United States, 2010 to 2018. American Journal of Obstetrics and Gynecology, 227(5), 751.e1\u2013751.e10. https:\/\/doi.org\/10.1016\/J.AJOG.2022.06.002","DOI":"10.1016\/j.ajog.2022.06.002"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics. (2008). Hospital discharge of the high-risk neonate. Pediatrics, 122(5), 1126\u20131129. https:\/\/doi.org\/10.1542\/peds.2008-2174","DOI":"10.1542\/peds.2008-2174"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Arora, I., Bhandekar, H., Lakra, A., Lakra, M.S., & Khadse, S.S. (2022). Filling the gaps for feeding difficulties in neonates with hypoxic-ischemic encephalopathy. Cureus, 14(8), e28564. https:\/\/doi.org\/10.7759\/cureus.28564","DOI":"10.7759\/cureus.28564"},{"key":"ref3","unstructured":"Arvedson, J.C., Brodsky, L., & Lefton-Greif, M.A. (2020). 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International Journal of Speech-Language Pathology, 25(6), 893\u2013902. https:\/\/doi.org\/10.1080\/17549507.2022.2147217","DOI":"10.1080\/17549507.2022.2147217"},{"key":"ref30","unstructured":"Maltese, A., Gallai, B., Marotta, R., Lavano, F., Lavano, S.M., Tripi, G., Romano, P., D\u2019Oro, L., & Salerno, M. (2017). The synactive theory of development: The keyword for neurodevelopmental disorders. Acta Medica Mediterranea, 33, 1257\u20131263. https:\/\/doi.org\/10.19193\/0393-6384_2017_2s_194"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Martinez-Biarge, M., Diez-Sebastian, J., Wusthoff, C.J., Lawrence, S., Aloysius, A., Rutherford, M.A., & Cowan, F.M. (2012). Feeding and communication impairments in infants with central grey matter lesions following perinatal hypoxiceischaemic injury. European Journal of Paediatric Neurology, 16(6), 688\u2013696. https:\/\/doi.org\/10.1016\/j.ejpn.2012.05.001","DOI":"10.1016\/j.ejpn.2012.05.001"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Masaba, B.B., & Mmusi-Phetoe, R.M. (2020). Neonatal survival in sub-Sahara: A review of Kenya and South Africa. Journal of Multidisciplinary Healthcare, 13, 709\u2013716. https:\/\/doi.org\/10.2147\/JMDH.S260058","DOI":"10.2147\/JMDH.S260058"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Medoff-Cooper, B., Shults, J., & Kaplan, J. (2009). Sucking behavior of preterm neonates as a predictor of developmental outcomes. Journal of Developmental and Behavioral Pediatrics, 30(1), 16\u201322. https:\/\/doi.org\/10.1097\/DBP.0B013E318196B0A8","DOI":"10.1097\/DBP.0b013e318196b0a8"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Miller, S.P., Ramaswamy, V., Michelson, D., Barkovich, A.J., Holshouser, B., Wycliffe, N., Glidden, D.V., Deming, D., Partridge, J.C., Wu, Y.W., Ashwal, S., & Ferriero, D.M. (2005). Patterns of brain injury in term neonatal encephalopathy. Journal of Pediatrics, 146(4), 453\u2013460. https:\/\/doi.org\/10.1016\/j.jpeds.2004.12.026","DOI":"10.1016\/j.jpeds.2004.12.026"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Mistry, S., & Hamdy, S. (2008). Neural control of feeding and swallowing. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 709\u2013728. https:\/\/doi.org\/10.1016\/J.PMR.2008.05.002","DOI":"10.1016\/j.pmr.2008.05.002"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Mutanana, N., Tsvere, M., & Chiweshe, M.K. (2020). General side effects and challenges associated with anti-epilepsy medication: A review of related literature. African Journal of Primary Health Care and Family Medicine, 12(1), e1\u2013e5. https:\/\/doi.org\/10.4102\/PHCFM.V12I1.2162","DOI":"10.4102\/phcfm.v12i1.2162"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Quattrocchi, C.C., Longo, D., Delfino, L.N., Cilio, M.R., Piersigilli, F., Capua, M.D., Seganti, G., Danhaive, O., & Fariello, G. (2010). Dorsal brain stem syndrome: MR imaging location of brain stem tegmental lesions in neonates with oral motor dysfunction. American Journal of Neuroradiology, 31(8), 1438\u20131442. https:\/\/doi.org\/10.3174\/ajnr.A2103","DOI":"10.3174\/ajnr.A2103"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Ross, E.S., & Philbin, M.K. (2011). Supporting oral feeding in fragile infants: An evidence-based method for quality bottle-feedings of preterm, ill, and fragile infants. Journal of Perinatal and Neonatal Nursing, 25(4), 349\u2013357. https:\/\/doi.org\/10.1097\/JPN.0b013e318234ac7a","DOI":"10.1097\/JPN.0b013e318234ac7a"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Shandley, S., Capilouto, G., Tamilia, E., Riley, D.M., Johnson, Y.R., & Papadelis, C. (2021). Abnormal nutritive sucking as an indicator of neonatal brain injury. Frontiers in Pediatrics, 8, 599\u2013633. https:\/\/doi.org\/10.3389\/fped.2020.599633","DOI":"10.3389\/fped.2020.599633"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Straathof, E.J.M., Hamer, E.G., Hensens, K.J., La Bastide-van Gemert, S., Heineman, K.R., & Hadders-Algra, M. (2022). Development of muscle tone impairments in high-risk infants: Associations with cerebral palsy and cystic periventricular leukomalacia. European Journal of Paediatric Neurology, 37, 12\u201318. https:\/\/doi.org\/10.1016\/j.ejpn.2021.12.015","DOI":"10.1016\/j.ejpn.2021.12.015"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Tagin, M.A., Woolcott, C.G., Vincer, M.J., Whyte, R.K., & Stinson, D.A. (2012). Hypothermia for neonatal hypoxic ischemic encephalopathy: An updated systematic review and meta-analysis. Archives of Pediatrics and Adolescent Medicine, 166(6), 558\u2013566. https:\/\/doi.org\/10.1001\/archpediatrics.2011.1772","DOI":"10.1001\/archpediatrics.2011.1772"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Thoyre, S.M., & Carlson, J. (2003). Occurrence of oxygen desaturation events during preterm infant bottle feeding near discharge. Early Human Development, 72(1), 1\u201315. https:\/\/doi.org\/10.1016\/S0378-3782(03)00008-2","DOI":"10.1016\/S0378-3782(03)00008-2"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"VandenBerg, K.A. (2007). Individualized developmental care for high risk newborns in the NICU: A practice guideline. Early Human Development, 83(7), 433\u2013442. https:\/\/doi.org\/10.1016\/J.EARLHUMDEV.2007.03.008","DOI":"10.1016\/j.earlhumdev.2007.03.008"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Viswanathan, S., & Jadcherla, S. (2020). Feeding and swallowing difficulties in neonates: Developmental physiology and pathophysiology. Clinics in Perinatology, 47(2), 223\u2013241. https:\/\/doi.org\/10.1016\/j.clp.2020.02.005","DOI":"10.1016\/j.clp.2020.02.005"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Viviers, M., Kritzinger, A., & Graham, M. (2019). Reliability and validity of the neonatal feeding assessment scale (NFAS) for the early identification of dysphagia in moderate to late preterm neonates. African Health Sciences, 19(3), 2718\u20132727. https:\/\/doi.org\/10.4314\/ahs.v19i3.47","DOI":"10.4314\/ahs.v19i3.47"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Viviers, M., Kritzinger, A., & Vinck, B. (2016). Development of a clinical feeding assessment scale for very young infants in South Africa. The South African Journal of Communication Disorders, 63(1), e1\u2013e11. https:\/\/doi.org\/10.4102\/sajcd.v63i1.148","DOI":"10.4102\/sajcd.v63i1.148"},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Volpe, J.J. (2012). Neonatal encephalopathy: An inadequate term for hypoxic-ischemic encephalopathy. Annals of Neurology, 72(2), 156\u2013166. https:\/\/doi.org\/10.1002\/ana.23647","DOI":"10.1002\/ana.23647"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Wahyuni, L.K., Mangunatmadja, I., Kaban, R.K., Rachmawati, E.Z.K., Harini, M., Laksmitasari, B., & Nugraha, B. (2022). Factors affecting oral feeding ability in Indonesian preterm infants. Pediatric Reports, 14(2), 233\u2013243. https:\/\/doi.org\/10.3390\/pediatric14020031","DOI":"10.3390\/pediatric14020031"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"World Medical Association. (2025). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human participants. Journal of the American Medical Association, 333(1), 71\u201374. https:\/\/doi.org\/10.1001\/jama.2024.21972","DOI":"10.1001\/jama.2024.21972"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Zanardo, V., Gabrieli, C., Straface, G., Savio, F., & Soldera, G. (2017). The interaction of personality profile and lactation differs between mothers of late preterm and term neonates. 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