Optimizing Enteral Nutrition During and After Therapeutic Hypothermia: An Evidence-Based Practice Initiative

ABSTRACT Background: Feeding practices during therapeutic hypothermia (TH) vary widely across neonatal intensive care units, and many centers delay enteral nutrition because of concerns about gastrointestinal intolerance and necrotizing enterocolitis. Current evidence suggests that early, clinically guided enteral feeding may be safe and beneficial for neonates with hypoxic-ischemic encephalopathy. An evidence-based feeding guideline was implemented to promote enteral nutrition during and after TH. Purpose: To evaluate whether initiating minimal enteral feeding in clinically stable neonates undergoing TH reduced time to full enteral feeds and parenteral nutrition days compared with delayed feeding practices. Methods: A preintervention and postintervention design was used to evaluate the impact of a standardized, stability-based feeding guideline. Retrospective data from neonates treated with TH between January 2023 and May 2025 established baseline outcomes (n = 26). The evidence-based practice change was implemented from June to December 2025, during which 8 neonates met inclusion criteria. Neonates who died were excluded. Results: The median time to full enteral feeds decreased by 18% (from 8.5 to 7 days). Parenteral nutrition days remained unchanged (median 6 days), potentially reflecting the conservative feeding advancement incorporated into the guideline. No feeding-related complications occurred among neonates who received enteral feeds during TH. Implications for Practice and Research: Our findings provide evidence for the feasibility and safety of minimal enteral feeding in clinically stable neonates undergoing TH. Earlier feeding may shorten time to full enteral nutrition and reduce reliance on parenteral nutrition without increasing feeding-related complications. Larger studies are needed to further evaluate optimal feeding strategies during TH.