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

Oral feeding should be mindful of individual ability. It is important that caregivers and parents are made aware of the infant's behavioral signs to prevent distress. This type of feeding is based on responding to infant cues, and we call it "infant driven." The traditional type of feeding is characterized by prescribing a predefined amount of liquid to be given at scheduled times and we call it "practitioner driven."

To assess whether infant-driven feeding results in earlier full oral feeding compared to practitioner-driven feeding.

We included randomized controlled trials (RCTs) and searched MEDLINE and the Cochrane Library on 26 June 2024. The primary outcome was days to full oral feeding, and the effect measure was the mean difference. A meta-analysis was conducted using the inverse variance method and random effects model, and we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Twelve RCTs matched the inclusion criteria. Of those, five studies were included in a meta-analysis. The estimated mean difference favored infant-driven groups when compared to practitioner-driven groups: -4.93 (95% confidence interval -6.60 to -3.26, p < 0.00001, I ²  = 66%). The certainty of the evidence was graded as moderate.

The evidence base is compatible with a slight favorable effect of infant-driven feeding of preterm infants compared to practitioner-driven feeding of preterm infants. Future studies could provide more data on adverse events during feeding and add information obtained from follow-up at home.