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

Pediatric Research (2025)Cite this article

Abstract

Background

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).

Methods

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.

Results

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).

Conclusion

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.

Impact

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.

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Fig. 1: Participant flowchart for the enrollment of full-term neonates with FDs.
Fig. 2: Etiological spectrum of feeding difficulties in full-term neonates.
Fig. 3: Diagnostic yield analysis of different tests.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all patients, Yihao Zhou, and Shiyu Ji for their kind input. All phases of this study were supported by Sichuan Natural Science Foundation (2023NSFSC1604) and Future Medical Scientist Clinical Postdoctoral Program of Children’s Hospital of Fudan University.

Author information

Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China

    Jing Wang, Jiaqi Mao, Bi Ze, Mengmeng Ge, Liyuan Hu & Guoqiang Cheng

  2. Center for Molecular Medicine, Children’s Hospital of Fudan University, Shanghai, China

    Xinran Dong, Bingbing Wu, Yulan Lu, Huijun Wang & Wenhao Zhou

  3. Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China

    Lin Yang

  4. Department of Neonatology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Tiantian Xiao

  5. Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China

    Wenhao Zhou

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Contributions

Tiantian Xiao and Wenhao Zhou conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript. Jing Wang designed the data collection instruments, collected data, carried out the initial analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. Jiaqi Mao, Bi Ze, Mengmeng Ge designed the data collection instruments, collected data, carried out the initial analyses, and critically reviewed and revised the manuscript. Liyuan Hu, Dong Xinran, Yulan Lu, and Bingbing Wu coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. Guoqiang Cheng and Lin Yang conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Tiantian Xiao or Wenhao Zhou.

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Competing interests

The authors declare no competing interests.

Consent statement

This study protocol was reviewed and approved by Children’s Hospital of Fudan University, approval number 2015-169. Participation in the survey was voluntary, and participants consented by choosing “Yes—I agree to participate” and signing.

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Wang, J., Mao, J., Ze, B. et al. Characterization and diagnosis of feeding difficulties in full-term neonates in NICUs: a multicenter study. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04257-w

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  • DOI: https://doi.org/10.1038/s41390-025-04257-w

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