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Early total enteral feeding in stable preterm infants: a systematic review and meta-analysis

Belal Alshaikh1, Dinesh Dharel1, Kamran Yusuf1

  • 1Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|June 29, 2019
PubMed

Insights

Early total enteral feeding (ETEF) is safe and feasible for stable preterm infants weighing over 1000-1200g. This approach may reduce late-onset sepsis and hospital stay, but further research is needed.

Area of Science:

  • Neonatalogy
  • Pediatric Gastroenterology
  • Clinical Nutrition

Background:

  • Early initiation of enteral nutrition is crucial for preterm infant development.
  • Current feeding guidelines often involve slow advancement, potentially delaying benefits.
  • The safety and efficacy of early total enteral feeding (ETEF) require further investigation.

Purpose of the Study:

  • To evaluate the safety and feasibility of ETEF in stable preterm infants.
  • To compare the incidence of necrotizing enterocolitis (NEC) and feeding intolerance between ETEF and traditional slow feeding advancement.
  • To assess other potential benefits of ETEF, such as reduced sepsis and hospital stay.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials.
  • Included studies compared ETEF with slow enteral feed advancement in very low birth weight (VLBW) infants.
  • Analyzed data from four trials involving 393 VLBW infants (birth weight >1000-1200g).

Main Results:

  • No significant difference in the risk of necrotizing enterocolitis (NEC) or feeding intolerance between ETEF and slow advancement groups.
  • ETEF was associated with a significantly lower risk of late-onset sepsis (RR: 0.43, 95% CI: 0.30-0.61).
  • Infants receiving ETEF experienced a shorter hospital stay by an average of 1.31 days.

Conclusions:

  • ETEF appears to be a safe and feasible feeding strategy for stable preterm infants within the specified birth weight range.
  • ETEF may offer benefits in reducing late-onset sepsis and length of hospital stay.
  • A large-scale randomized trial is recommended to confirm these findings and establish definitive clinical guidelines.
Abstract

Keywords:
Early feedingVLBWfeeding intolerancenecrotizing enterocolitispreterm infant

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