Hypoxic-ischemic encephalopathy (HIE) occurs when an infant’s brain is deprived of oxygen and blood flow during or shortly after birth. HIE affects 2–5 per 1,000 live births, and 20–40% of survivors develop lifelong neurodevelopmental impairments. Early identification is critical to initiate timely interventions, yet current diagnostic tools, such as MRI and cranial ultrasound, have practical limitations. This study investigates whether nutritive sucking patterns can serve as early, non-invasive biomarkers of neurological dysfunction in HIE, potentially enabling earlier long-term outcome risk and timing of interventions.

In this observational cohort study, a longitudinal analysis was conducted on 49 neurotypical (gestational age: 39.7 ± 1.5 weeks; 22 females) and 10 infants with HIE (gestational age: 39 ± 1.4 weeks; 5 males). Inclusion criteria for the HIE group included term-born infants diagnosed with HIE based on clinical criteria, evidence of encephalopathy, and neuroimaging findings. Nutritive sucking was assessed at 1, 2, 4, and 6 months of age during bottle feeding using an FDA approved feeding system. We estimated quantitative features of nutritive sucking (i.e., amplitude, smoothness, and frequency). We examined whether these features are different between neurotypical and HIE infants across time using a non-parametric mixed ANOVA test.

Compared to neurotypical infants, HIE infants exhibited reduced sucking smoothness at 1 month, reduced sucking amplitude at 2-4 months, and reduced sucking frequency at 6 months. Both groups showed significant developmental progression.