The Effectiveness of Herbal Medicine on Feeding Intolerance in Preterm Infants: A Systematic Review and Meta-Analysis

Feeding intolerance (FI) refers to frequent feeding disruptions, that can adversely affect the growth, nutritional status, and long-term neurodevelopmental outcomes of preterm infants (born at 37 ≤ weeks of gestation). This review evaluated the efficacy of herbal medicine (HM) for FI compared to conventional treatments.

An extensive search across 11 databases was conducted, including English, Chinese, and Korean databases, from August 1 to December 7, 2023. Our inclusion criteria were randomized clinical trials (RCTs) that compared the efficacy of HM with conventional treatments against conventional treatments alone. Statistical analyses involved calculating the mean difference (MD), standardized mean difference (SMD), and risk ratio (RR) with a 95% confidence interval (CI), and assessing the bias risk (RoB 2) using Review Manager Version 5.4 software. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating system.

The meta-analysis showed that combined HM treatments exhibited superior outcomes compared to conventional treatments alone. The time to achieve full enteral feeding (n = 638, random effects MD: -2.91, 95% CI: -4.13 to -1.69), duration of FI (n = 366, fixed effects MD: -1.58, 95% CI: -2.01 to -1.16), and total effective rate (n = 774, random effects RR: 1.26, 95% CI: 1.11 to 1.42) improved with HM. Mild adverse events, such as diarrhea and increased defecation frequency, occurred in 4.17% of the HM combined group, compared to 1.42% in the conventional treatment group.

The findings suggest that combining HM with conventional treatments could be more effective for FI, suggesting HM as an early intervention for FI in preterm infants. Further research on the efficacy and safety of HM in preterm infants is necessary.