Normally a neonate is started on oral or enteral tube feeding soon after delivery. This feeding may be withheld if the child is seriously ill or has findings that may suggest serious illness.


Clinical findings that may indicate a serious underlying condition:

(1) severe neurologic depression

(2) respiratory distress

(3) moderate to marked abdominal distention

(4) failure to pass stool within 24 hours of delivery

(5) signs suggesting significant sepsis

(6) conditions associated with compromised gastrointestinal tract (signs of prolonged asphyxia, hypoxemia, hypotension and/or Apgar score <= 5 at 5 minutes after delivery)


Signs of respiratory distress: - one of the following:

(1) respiratory rate > 80 breaths per minute

(2) respiratory rate 60-80 breaths per minute AND any of the following:

(2a) nasal flaring

(2b) grunting

(2c) retractions


Some of these findings (abdominal distention, failure to pass stool) are indications for an evaluation of the gastrointestinal tract to exclude congenital anatomic or functional disorders that may necessitate surgery.


If there are reasons to suspect that the gastrointestinal tract has been compromised by hypoxia and/or poor perfusion, then feedings may be withheld for 72+ hours in order to give the mucosa a chance "to recover".


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