Early Exclusive Enteral Feeding in Preterm Infants: A Meta-Analysis

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Clinical Nutrition

Background:

• Early exclusive enteral feeding (EEF) in preterm infants may improve nutrition and reduce costs.
• Concerns exist regarding potential adverse outcomes, particularly necrotizing enterocolitis (NEC).

Purpose of the Study:

• To compare the safety and efficacy of EEF versus progressive enteral feed (PEF) in preterm infants.
• To determine if EEF is associated with adverse effects, specifically NEC.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library, and clinical trial registries.
• Included 11 RCTs with 3145 preterm infants (27+0 to 36+0 weeks).

Main Results:

• No significant difference in NEC stage 2 or greater, hypoglycemia, or sepsis between EEF and PEF groups.
• EEF was associated with shorter time to full feeds, reduced intravenous fluid duration, faster birth weight regain, and shorter hospital stay.
• Certainty of evidence (COE) was moderate for NEC and low to very low for other outcomes.

Conclusions:

• EEF is a feasible feeding strategy for preterm infants.
• Based on moderate COE, EEF does not appear to increase NEC risk.
• Larger, diverse trials are needed to confirm safety, evaluate benefits (e.g., cost), and assess long-term outcomes.