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Fast Feed Advancement for Preterm and Low Birth Weight Infants: A Systematic Review and Meta-analysis
Wen-Chien Yang1, Alexandra Fogel2, Molly E Lauria1,3
1The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia.
Insights
Fast feed advancement for preterm infants likely reduces hospital stay and morbidity but may slightly increase neurodevelopmental risks. Further research is needed for long-term outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Clinical Trials
Background:
- Fast enteral feed advancement in preterm and low birth weight infants may reduce hospital stay and infection.
- However, concerns exist regarding potential increases in adverse outcomes with rapid feeding protocols.
Purpose of the Study:
- To compare the effects of fast feed advancement (≥30 ml/kg/day) versus slow feed advancement (<30 ml/kg/day) in preterm and low birth weight infants.
- To assess the impact on mortality, morbidity, growth, and neurodevelopmental outcomes.
Main Methods:
- Systematic review and meta-analysis of 12 randomized controlled trials (RCTs) involving 4291 participants.
- Searched multiple databases (Medline, Scopus, Web of Science, CINAHL, Index Medicus) up to June 30, 2021.
- Analyzed primary outcomes including mortality, morbidity (necrotizing enterocolitis, sepsis, feed intolerance, apnea), growth, and neurodevelopment using random-effects models and the Cochrane Risk of Bias 2 tool.
Main Results:
- Fast feed advancement showed moderate certainty evidence for slight reductions in mortality, necrotizing enterocolitis, sepsis, and feed intolerance.
- High certainty evidence indicated a reduction in time to regain birth weight (mean difference -3.69 days).
- Moderate certainty evidence suggested a likely reduction in hospitalization duration (mean difference -3.08 days) and potential reduction in apnea risk.
Conclusions:
- Fast feed advancement significantly reduces time to regain birth weight and hospital stay duration.
- It is associated with a likely slight reduction in neonatal morbidity and mortality.
- Potential for a slight increase in neurodevelopmental disability risk necessitates further investigation into long-term effects.
Background And Objectives:
Fast feed advancement may reduce hospital stay and infection but may increase adverse outcomes in preterm and low birth weight infants. The objective of this study was to assess effects of fast feed advancement (≥30 ml/kg per day) compared with slow feed advancement (<30 ml/kg per day) in preterm and low birth weight infants.
Methods:
Data sources include Medline, Scopus, Web of Science, CINAHL, and Index Medicus through June 30, 2021. Randomized trials were selected. Primary outcomes were mortality, morbidity, growth, and neurodevelopment. Data were extracted and pooled using random-effects models. The Cochrane Risk of Bias 2 tool was used.
Results:
A total of 12 RCTs with 4291 participants were included. At discharge, there was moderate certainty evidence that fast advancement likely slightly reduces the risk of: mortality (relative risk [RR] 0.93, 95% confidence interval [95% CI] 0.73 to 1.18, I2 = 18%, 11 trials, 4132 participants); necrotizing enterocolitis (RR 0.89, 95% CI 0.68 to 1.15, I2 = 0%, 12 trials, 4291 participants); sepsis (RR 0.92, 95% CI 0.83 to 1.03, I2 = 0%, 9 trials, 3648 participants); and feed intolerance (RR 0.92, 95% CI 0.77 to 1.10, I2 = 0%, 8 trials, 1114 participants). Fast feed advancement may also reduce the risk of apnea (RR 0.72, 95% CI 0.47 to 1.12, I2 = 0%, low certainty, 2 trials, 153 participants). Fast feed advancement decreases time to regain birth weight (mean difference [MD] -3.69 days, 95% CI -4.44 to -2.95, I2 = 70%, high certainty, 6 trials, 993 participants,) and likely reduces the duration of hospitalization (MD -3.08 days, 95% CI -4.34 to -1.81, I2 = 77%, moderate certainty, 7 trials, 3864 participants). Limitations include heterogeneity between studies and small sample sizes.
Conclusions:
Fast feed advancement reduces time to regain birth weight and likely reduces the length of hospital stay; it also likely reduces the risk of neonatal morbidity and mortality slightly. However, it may increase the risk of neurodevelopmental disability slightly. More studies are needed to understand the long-term effects of fast feed advancement.
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