Hydranencephaly is a congenital anomaly thought to be caused by an in utero ischemic event causing almost total destruction of the cerebral cortex, which is replaced by fluid-filled sacs. Neurologic prognosis is poor, but since the subcortical area may be relatively preserved, activities such as respiration and nippling can be intact in term and near-term infants. Some hydranencephalic infants can nipple well and go home to live for variable lengths of time. However,the process of nippling has a developmental aspect with mature patterns of coordinated suck and swallow not occurring until 34-36 weeks of gestational age or later. With modern obstetric ultrasonography, hydranencephaly may be diagnosed prior to delivery. Progressive head enlargement may necessitate a C-section, placing the mother's life at increased risk. We present a case of a hydranencephalic neonate at 35 weeks of gestation diagnosed in utero. Labor was induced to avoid the risk of a C-section. Prior to labor,the family requested the withholding of all therapies, including nutrition and hydration. While tube feedings are generally regarded as being artificial in nature, since nippling skills may not be developed in a normal 35-week infant, could gavage feeding such an infant until the lack of nippling is clearly abnormal be a better recommendation? This child quickly succumbed to pulmonary disease, and the nutrition/hydration issue was never resolved in the context of patient care. We propose that parents of premature infants with hydranencephaly should consider tube feedings until such time as normal developmental nippling occurs or the lack of nippling is documented to be an actual feeding pathology. Because of its minimal burden and possible comfort, a bottle should always be offered to infants who can nipple. Failure to take nourishment at this point requires further ethical analysis and decision-making regarding the use of artificial feeding. Finally, the neonatal team should be involved early in the discussion of preterm induction and post-natal care of such infants.