Abstract
Early enteral feeding is vital for the physical health of preterm infants. However, there is uncertainty regarding the effects of early enteral feeding on health outcomes in preterm infants. Hence, we aimed to synthesise evidence from systematic reviews (SRs) to evaluate the effects of early enteral feeding on health outcomes in preterm infants. We conducted a literature search in PubMed, Web of Science, Scopus, and the Cochrane Database of Systematic Reviews. SRs selection followed clear inclusion and exclusion criteria. Two reviewers reached a consensus for the inclusion of SRs. The certainty of evidence and the quality of reviews using the GRADE and AMSTAR tools, respectively. We included nine SRs in this review. The effectiveness of early enteral feeding on health outcomes in preterm infants is mainly divided into six primary outcomes: increase the weight gain, reduce the incidence of feed intolerance, shorten the duration of full enteral feeding, reduce the length of hospital stay, reduce the incidence of necrotizing enterocolitis, and decrease the mortality risk. The overall quality of the included SRs was high, whereas most of the evidence was of low or very low certainty. Our results show the impact of early enteral feeding on health outcomes in preterm infants. Although the currently available data indicate that early enteral feeding may improve the health outcomes of preterm infants, additional clinical observation and investigation are required to evaluate the long-term health outcomes of preterm infants who receive early enteral feeding.
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References
Kennedy KA, Tyson JE, Chamnanvanikij S. Early versus delayed initiation of progressive enteral feedings for parenterally fed low birth weight or preterm infants. Cochrane Database Syst Rev. 2000;2:Cd001970.
Thoene M, Anderson-Berry A. Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits. Nutrients. 2021;13:2289.
Munch A, Buhrer C, Longardt AC. Digestive enzyme replacement relieves growth failure in preterm infants with poor exocrine pancreatic function: a retrospective case series. Eur J Pediatr. 2021;180:2951–8.
Black A. Breastfeeding the premature infant and nursing implications. Adv Neonatal Care. 2012;12:10–1.
Section on, B. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41.
Tao J, Mao J, Yang J, Su Y. Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs. Eur J Clin Nutr. 2020;74:1122–31.
Liu K, Tao J, Yang J, Li Y, Su Y, Mao J. Effectiveness of feeding supplementation in preterm infants: an overview of systematic reviews. BMC Pediatr. 2022;22:20.
Kozeniecki M, Fritzshall R. Enteral Nutrition for Adults in the Hospital Setting. Nutr Clin Pr. 2015;30:634–51.
Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet. 1990;336:1519–23.
Abdelmaaboud M, Mohammed A. Early Versus Late Minimal Enteral Feeding in Weeks Preterm Growth-Restricted neonates with Abnormal Antenatal Doppler Studies. J Matern Fetal Neonatal Med. 2012:21. https://doi.org/10.3109/14767058.2012.695821.
Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev. 2013;3:CD000504.
Konnikova Y, Zaman MM, Makda M, D’Onofrio D, Freedman SD, Martin CR. Late Enteral Feedings Are Associated with Intestinal Inflammation and Adverse Neonatal Outcomes. PLoS One. 2015;10:e0132924.
Panchal H, Athalye-Jape G, Patole S. Oropharyngeal Colostrum for Preterm Infants: A Systematic Review and Meta-Analysis. Adv Nutr. 2019;10:1152–62.
Garg BD, Balasubramanian H, Kabra NS, Bansal A. Effect of oropharyngeal colostrum therapy in the prevention of necrotising enterocolitis among very low birthweight neonates: A meta-analysis of randomised controlled trials. J Hum Nutr Diet. 2018;31:612–24.
Berseth CL, Bisquera JA, Paje VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2003;111:529–34.
Brown EG, Sweet AY. Preventing necrotizing enterocolitis in neonates. JAMA. 1978 ;240:2452–4.
Pollock M, Fernandes RM, Becker LM, et al. Chapter V: overviews of reviews. In: Cochrane Handbook for Systematic Reviews of Interventions. Accessed July 14, 2020 /handbook/current/chapter-v.
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62:1013–20.
Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rat Qual Evid–study Limit (risk bias) J Clin Epidemiol. 2011;64:407–15.
Meerpohl JJ, Langer G, Perleth M, Gartlehner G, Kaminski-Hartenthaler A, Schünemann H. GRADE-Leitlinien: 4. Bewertung der Qualität der Evidenz – Studienlimitationen (Risiko für Bias). Z für Evidenz, Fortbild und Qualät im Gesundheitswesen. 2012;106:457–69.
Alshaikh B, Dharel D, Yusuf K, Singhal N. Early total enteral feeding in stable preterm infants: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021;34:1479–86.
Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. 2021;8:CD001241.
Ramaswamy VV, Bandyopadhyay T, Ahmed J, Bandiya P, Zivanovic S, Roehr CC. Enteral Feeding Strategies in Preterm Neonates </=32 weeks Gestational Age: A Systematic Review and Network Meta-Analysis. Ann Nutr Metab. 2021;77:204–20.
Kwok TC, Dorling J, Gale C. Early enteral feeding in preterm infants. Semin Perinatol. 2019;43:151159.
Walsh V, Brown JVE, Copperthwaite BR, Oddie SJ, McGuire W. Early full enteral feeding for preterm or low birth weight infants. Cochrane Database Syst Rev. 2020;12:CD013542.
Ibrahim NR, Van Rostenberghe H, Ho JJ, Nasir A. Short versus long feeding interval for bolus feedings in very preterm infants. Cochrane Database Syst Rev. 2021;8:CD012322.
Morgan J, Young L, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst. Rev. 2014;12:CD001970.
Moe-Byrne T, Brown JV, McGuire W. Glutamine supplementation to prevent morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2016;1:CD001457.
Pammi M, Suresh G. Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2020;3:CD007137.
Funding
This work was supported by National Natural Science Foundation of China (81601330). The funder contributed to define the research theme, be fully accountable for ensuring the integrity and accuracy of the work, analyze the data and interpret the results.
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QL contributed to collate and analyze the data, draft and revise the manuscript according to the Cochrane Handbook. Adilaabudusalamu contributed to screen and collaborate on data analysis. JY contributed to analyze the data and interpret the results. YS contributed to define the research theme, analyze the data and interpret the results, revise the manuscript, and was responsible for the layout and use of funds. All the authors have read and approved the final manuscript and reported no declarations of interest.
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Liu, K., Abudusalamu, A., Yang, J. et al. Effectiveness of early enteral feeding on health outcomes in preterm infants: an overview of systematic reviews. Eur J Clin Nutr 77, 628–636 (2023). https://doi.org/10.1038/s41430-022-01223-1
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DOI: https://doi.org/10.1038/s41430-022-01223-1