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Three-hourly versus two-hourly feeding interval in stable preterm infants: an updated systematic review and

Jogender Kumar1, Jitendra Meena1, Pradeep Debata2

  • 1Department of Pediatrics, Neonatal Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012.

European Journal of Pediatrics
|February 11, 2022
PubMed

Insights

Three-hourly feeding is safe for stable preterm infants weighing 1000-1500 grams. For very low birth weight infants (<1000g), two-hourly feeding may be preferable due to faster achievement of full feeds.

Area of Science:

  • Neonatal Nutrition and Gastroenterology
  • Pediatric Critical Care

Background:

  • Current clinical practice often utilizes two-hourly feeding schedules for preterm infants without strong evidence.
  • Emerging evidence suggests three-hourly feeding may be safe in stable preterm infants.

Purpose of the Study:

  • To systematically compare the benefits and harms of three-hourly versus two-hourly feeding schedules in preterm infants.
  • To evaluate the impact of feeding intervals on necrotizing enterocolitis (NEC), mortality, time to full feeds, and hospital stay.

Main Methods:

  • Systematic review and random-effects meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple electronic databases and trial registries up to November 16, 2021.
  • Included six trials involving 872 preterm infants.

Main Results:

  • No significant difference in the incidence of stage II/III NEC or any stage NEC between feeding schedules (low to very low certainty evidence).
  • No significant difference in achieving full enteral feeds or hospital stay.
  • Subgroup analysis indicated that infants <1000g in the three-hourly group achieved full feeds slower than in the two-hourly group (low certainty).

Conclusions:

  • Three-hourly feeding is safe for stable preterm infants weighing 1000-1500 grams.
  • For infants with birth weight <1000 grams, evidence is insufficient to recommend an optimal interval, but a two-hourly schedule might be preferable.
  • Further research is needed to establish optimal feeding intervals for very low birth weight infants.

Keywords:
Feed intoleranceInfantsNecrotizing enterocolitisNutritionSmall for gestational age

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