Nutrition guidelines for preterm infants: A systematic review.

Area of Science:

• Neonatal Nutrition
• Evidence-Based Medicine
• Clinical Practice Guidelines

Background:

• Substantial practice variation exists in preterm infant nutrition due to lack of consensus on optimal feeding strategies.
• Current nutrition guidelines for preterm infants often lack stakeholder involvement and rigorous development processes.
• There is a need to assess the quality, consistency, and identify gaps in existing preterm infant nutrition guidelines.

Approach:

• A systematic search identified nutrition guidelines for preterm infants published between 2012 and 2023.
• Two independent reviewers screened articles and extracted recommendations.
• Four reviewers appraised guideline quality using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument.

Key Points:

• Only 26% of the 27 included guidelines were of high quality, with most lacking stakeholder input and rigorous development.
• Significant variation exists in recommendations for nutrient intakes and monitoring, despite consistency in feed type and breastmilk fortification among high-quality guidelines.
• Many recommendations lacked clear reporting on the certainty of evidence and strength of recommendation, with gaps often attributed to very low certainty evidence.

Conclusions:

• Future preterm infant nutrition guidelines must adopt standard development methods, including stakeholder engagement, to improve reporting clarity.
• Enhanced reporting on the strength of recommendations and certainty of evidence is crucial for guideline usability.
• Further research is needed to provide robust evidence for macro/micronutrient intakes, breastmilk fortification, and adequacy markers in preterm infants.