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Early Enteral Feeding for Preterm or Low Birth Weight Infants: a Systematic Review and Meta-analysis
Ramaa Chitale1, Kacey Ferguson1, Megan Talej1
1The George Washington University, Milken Institute School of Public Health, Washington, DC.
Insights
Initiating enteral feeding within 72 hours of birth likely reduces mortality and hospital stay duration for preterm infants. This early feeding strategy may also decrease sepsis risk and improve weight outcomes.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Early enteral feeding in preterm and low birth weight infants is linked to potential adverse outcomes like necrotizing enterocolitis.
- The optimal timing for initiating enteral nutrition in vulnerable newborns remains a critical clinical question.
Purpose of the Study:
- To evaluate the impact of early enteral feeding initiation (within the first 72 hours post-birth) versus delayed initiation on neonatal outcomes.
- To synthesize evidence from randomized controlled trials (RCTs) on the effects of feeding timing.
Main Methods:
- A systematic review and meta-analysis of RCTs were conducted.
- Searches were performed in Medline, Scopus, Web of Science, and CINAHL up to June 30, 2021.
- Data from 14 RCTs involving 1505 participants were analyzed using random-effects models.
Main Results:
- Early enteral feeding (within 72 hours) likely reduced mortality at discharge and 28 days (moderate certainty evidence).
- Hospitalization duration was likely decreased with early feeding (moderate certainty evidence).
- Potential reductions in sepsis and improved weight at discharge were observed, though evidence certainty varies for other outcomes like necrotizing enterocolitis.
Conclusions:
- Initiating enteral feeding within 72 hours after birth is associated with probable benefits, including reduced mortality and shorter hospital stays.
- The findings suggest that early feeding may also lower the incidence of sepsis and positively impact infant weight.
- While evidence supports early feeding, its effect on specific morbidities like necrotizing enterocolitis requires further investigation.
Context:
Early enteral feeding has been associated with adverse outcomes such as necrotizing enterocolitis in preterm and low birth weight infants.
Objectives:
To assess effects of early enteral feeding initiation within the first days after birth compared to delayed initiation.
Data Sources:
Medline, Scopus, Web of Science, CINAHL from inception to June 30, 2021.
Study Selection:
Randomized trials (RCTs) were included. Primary outcomes were mortality, morbidity, growth, neurodevelopment, feed intolerance, and duration of hospitalization.
Data Extraction:
Data were extracted and pooled with random-effects models.
Results:
We included 14 randomized controlled trials with 1505 participants in our primary analysis comparing early (<72 hours) to delayed (≥72 hours) enteral feeding initiation. Early initiation likely decreased mortality at discharge and 28 days (1292 participants, 12 trials, relative risk 0.69, 95% confidence interval [95% CI] 0.48-0.99, moderate certainty evidence) and duration of hospitalization (1100 participants, 10 trials, mean difference -3.20 days, 95%CI -5.74 to -0.66, moderate certainty evidence). The intervention may also decrease sepsis and weight at discharge. Based on low certainty evidence, early feeding may have little to no effect on necrotizing enterocolitis, feed intolerance, and days to regain birth weight. The evidence is very uncertain regarding the effect of initiation time on intraventricular hemorrhage, length, and head circumference at discharge.
Conclusions:
Enteral feeding within 72 hours after birth likely reduces the risk of mortality and length of hospital stay, may reduce the risk of sepsis, and may reduce weight at discharge.
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