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Feeding in Preterm Neonates With Antenatal Doppler Abnormalities: A Systematic Review and Meta-Analysis
Rajendra Prasad Anne1, Abhishek S Aradhya2, Srinivas Murki3
1From the All India Institute of Medical Sciences, Hyderabad, Telangana, Indiathe.
Insights
Early enteral feeding in preterm neonates with antenatal Doppler abnormalities does not increase necrotizing enterocolitis (NEC) or mortality. However, evidence quality is low, and data on feed advancement speed is limited.
Area of Science:
- Neonatology
- Perinatal Medicine
- Evidence-Based Medicine
Background:
- Antenatal Doppler abnormalities in preterm neonates can indicate altered fetal circulation.
- Optimal feeding strategies for these vulnerable infants remain a critical clinical question.
Purpose of the Study:
- To systematically review and meta-analyze evidence on feed initiation and advancement in preterm neonates with antenatal Doppler abnormalities.
- To determine the most appropriate feeding practices to improve outcomes.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched multiple databases including PubMed, Embase, and Cochrane.
- Assessed risk of bias and certainty of evidence using established methodologies.
Main Results:
- Early enteral feeding did not significantly increase necrotizing enterocolitis (NEC) or mortality.
- A trend towards increased feeding intolerance was observed.
- Early feeding significantly reduced age at full enteral feeds, duration of total parenteral nutrition, and hospital-acquired infections.
- Rapid feed advancement decreased age at full enteral feeds without adverse effects.
Conclusions:
- Low-certainty evidence suggests early feeding is safe regarding NEC and mortality in this population.
- Insufficient data exists to guide the optimal speed of feed advancement.
- Further high-quality research is needed to refine feeding protocols.
Objectives:
In this systematic review and meta-analysis, we attempted to determine the most appropriate feed initiation and advancement practices in preterm neonates with antenatal Doppler abnormalities.
Methods:
We included randomized controlled trials comparing different feed initiation and advancement practices in neonates with antenatal Doppler abnormalities. The databases of PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar were searched on February 25, 2022. The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RevMan 5.4 was used for data analysis.
Results:
Of the 1499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% confidence interval (CI) 0.71-1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47-1.48; 5 studies, 642 participants). A trend was noted towards an increase in feeding intolerance (RR 1.23, 95% CI 0.98-1.56; 5 studies, 715 participants). There was a significant reduction in age at full enteral feeds, duration of total parental nutrition, and rates of hospital-acquired infections. Rapid feed advancement decreased the age at full enteral feeds without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant.
Conclusion:
There is low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.
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