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Infant-driven versus Practitioner-driven Feeding of Preterm Infants: A Systematic Review of Randomized Controlled

Kevin Bernhard Arnolds¹, Frank Peinemann^1,2

¹University Children's Hospital of CologneUniversity of CologneCologneGermany.

Geburtshilfe Und Frauenheilkunde

|June 25, 2026

Summary

Infant-driven feeding, which responds to baby cues, helps preterm infants achieve full oral feeding faster than practitioner-driven schedules. This approach shows a significant benefit with moderate certainty of evidence.

Keywords:

infant nutritional physiological phenomena meta-analysis neonatal intensive care perinatal center preterm infant randomized controlled trials

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Area of Science:

Neonatal care
Pediatric nutrition
Evidence-based medicine

Background:

Oral feeding practices for infants vary, with "infant-driven" feeding responding to cues and "practitioner-driven" feeding following set schedules.
Caregiver awareness of infant behavioral signs is crucial for distress prevention during feeding.

Purpose of the Study:

To compare the effectiveness of infant-driven feeding versus practitioner-driven feeding in achieving full oral feeding in infants.
To determine if infant-driven feeding leads to earlier establishment of oral feeding.

Main Methods:

A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
Searches were performed in MEDLINE and the Cochrane Library.
The primary outcome was days to full oral feeding, analyzed using a random effects model.

Main Results:

Twelve RCTs met the inclusion criteria, with five included in the meta-analysis.
Infant-driven feeding showed a statistically significant reduction in time to full oral feeding compared to practitioner-driven feeding (-4.93 days).
The certainty of the evidence was assessed as moderate.

Conclusions:

Infant-driven feeding demonstrates a favorable effect on achieving full oral feeding in preterm infants compared to practitioner-driven methods.
Further research is recommended to investigate adverse feeding events and long-term home follow-up outcomes.