Characterization and diagnosis of feeding difficulties in full-term neonates in NICUs: a multicenter study

Feeding difficulties significantly impact neonatal well-being. This study explores the clinical characteristics, etiologies, and diagnostic practices for full-term neonates with feeding difficulties in neonatal intensive care units (NICUs).

This retrospective cohort study recruited full-term infants admitted to NICUs participating in the China Neonatal Genome Project from March 2017 to December 2021, diagnosed with feeding difficulties persisting >72 h.

Among 220 patients, the most common symptoms were poor sucking (39.5%), vomiting (22.3%), and dysphagia (14.1%). High-yield diagnostic modalities included genetic tests (83/220, 37.3%), brain imaging (70/145, 48.3%), laryngoscopy (47/54, 87.0%), and muscle biopsy (12/28, 42.9%). A definitive etiology was identified through clinical evaluation in 100 cases (45.5%), 48 of which (21.8%) were subsequently confirmed by genetic testing. In an additional 35 cases (15.9%), genetic results contributed to diagnostic clarification or revision. Compared to neonates without genetic disorders, the 83 patients with genetic disorders were more likely to have persistent feeding difficulties, reduced muscle tone, craniofacial deformities, urinary and reproductive system malformations, and a need for invasive respiratory support (P < 0.05 for all).

Identifiable etiologies were found in over 60% cases, with genetic disorders representing a significant subset. Selective genetic testing and targeted diagnostic strategies are essential for managing feeding difficulties in this vulnerable population.

Feeding difficulties in full-term neonates admitted to NICUs remain under-recognized compared to those in preterm infants. This study provides a comprehensive overview of their clinical features and underlying etiologies, highlighting a substantial proportion with identifiable causes, including genetic and non-genetic factors (e.g., neuromuscular and gastrointestinal). By outlining the diagnostic yield of key modalities and their clinical relevance, our findings offer practical guidance for early evaluation of feeding difficulties in this vulnerable population.