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Early versus delayed enteral nutrition for preterm Neonates: A systematic review and meta-analysis of randomized

Abdulwahab Alqahtani1

  • 1Department of Pediatrics, College of Medicine, Najran University, Najran, Saudi Arabia.

Journal of Family Medicine and Primary Care
|December 17, 2025
PubMed

Insights

Starting enteral nutrition early for preterm infants increases feeding intolerance. Careful monitoring and individualized care are crucial for optimizing neonatal nutrition practices.

Area of Science:

  • Neonatalogy
  • Clinical Nutrition
  • Evidence-Based Medicine

Background:

  • Preterm neonates frequently experience difficulties with initiating enteral nutrition.
  • The optimal timing for starting enteral nutrition in premature infants is a topic of ongoing clinical debate.

Purpose of the Study:

  • To conduct a meta-analysis of randomized controlled trials (RCTs).
  • To compare early versus delayed enteral nutrition initiation in preterm neonates.
  • To synthesize current evidence on the impact of feeding timing on neonatal outcomes.

Main Methods:

  • Systematic literature search identifying eight RCTs.
  • Meta-analysis using a fixed-effects model.
  • Assessment of feeding intolerance as the primary outcome.

Main Results:

  • Early enteral feeding was associated with a significant increase in feeding intolerance in preterm infants (OR: 1.54, 95% CI: 1.18-2.01).
  • Individual studies showed varied results, indicating a need to consider patient-specific factors and local protocols.
  • Heterogeneity across studies suggests variability in outcomes based on population and protocol differences.

Conclusions:

  • Early enteral nutrition initiation in preterm neonates is linked to higher rates of feeding intolerance.
  • Clinicians should employ a nuanced approach, closely monitoring infants and adjusting nutrition strategies as needed.
  • Further large-scale RCTs with standardized protocols are necessary to refine clinical guidelines for neonatal enteral nutrition.
Abstract

Keywords:
Enteralmeta-analysisneonatespretermsystematic review

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