scholarly journals Enteral Feeding Strategies in Preterm Neonates ≤32 weeks Gestational Age: A Systematic Review and Network Meta-Analysis

2021 ◽  
pp. 1-17
Author(s):  
Viraraghavan Vadakkencherry Ramaswamy ◽  
Tapas Bandyopadhyay ◽  
Javed Ahmed ◽  
Prathik Bandiya ◽  
Sanja Zivanovic ◽  
...  
Keyword(s):  
Enteral Feeding ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Credible Interval ◽  
Stage Ii ◽  
Preterm Neonates ◽  
Feeding Strategies ◽  
Moderate Volume ◽  
Full Enteral Feeding ◽  
Critical Aspects

<b><i>Introduction:</i></b> Critical aspects of time of feed initiation, advancement, and volume of feed increment in preterm neonates remain largely unanswered. <b><i>Methods:</i></b> Medline , Embase, CENTRAL and CINAHL were searched from inception until 25th September 2020. Network meta-analysis with the Bayesian approach was used. Randomized controlled trials (RCTs) evaluating preterm neonates ≤32 weeks were included. Feeding regimens were divided based on the following categories: initiation day: early (&#x3c;72 h), moderately early (72 h–7 days), and late (&#x3e;7 days); advancement day: early (&#x3c;72 h), moderately early (72 h–7 days), and late (&#x3e;7 days); increment volume: small volume (SV) (&#x3c;20 mL/kg/day), moderate volume (MoV) (20–&#x3c; 30 mL/kg/day), and large volume (≥30 mL/kg/day); and full enteral feeding from the first day. Sixteen regimens were evaluated. Combined outcome of necrotizing enterocolitis (NEC) stage ≥ II or mortality before discharge was the primary outcome. <b><i>Results:</i></b> A total of 39 studies enrolled around 6,982 neonates. Early initiation (EI) with moderately early or late advancement using MoV increment enteral feeding regimens appeared to be most efficacious in decreasing the risk of NEC or mortality when compared to EI and early advancement with SV increment (risk ratio [95% credible interval]: 0.39 [0.12, 0.95]; 0.34 [0.10, 0.86]) (GRADE–very low). <b><i>Conclusions:</i></b> Early initiated, moderately early, or late advanced with MoV increment feeding regimens might be most appropriate in decreasing the risk of NEC stage ≥II or mortality. In view of the certainty of evidence being very low, adequately powered RCTs evaluating these 2 strategies are warranted.

scholarly journals Shorter Time to Full Preterm Feeding Using Intact Protein Formula: A Randomized Controlled Trial

2019 ◽  
Vol 16 (16) ◽  
pp. 2911 ◽  
Author(s):  
Maria Elisabetta Baldassarre ◽  
Antonio Di Mauro ◽  
Margherita Fanelli ◽  
Manuela Capozza ◽  
Jennifer L. Wampler ◽  
...  
Keyword(s):  
Breast Milk ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Intact Protein ◽  
Group Differences ◽  
Preterm Formula ◽  
Hydrolyzed Formula ◽  
Full Enteral Feeding

Background: This study was carried out to evaluate enteral feeding advancement and tolerance in preterm infants receiving one of two marketed formulas: intact protein preterm formula (IPF) or extensively hydrolyzed formula (EHF) for the first 14 feeding days. Methods: Primary outcome was days to full enteral feeding (≥140 mL/kg/day). Per protocol analyses included the following: all participants who met study entrance criteria and completed study feeding (primary) and those who received ≥75% enteral intake from study formula (subset). Mothers were encouraged to provide their breast milk. Results: Of the 65 enrolled (IPF: n = 32; EHF: n = 33), 60 completed study feeding per protocol (IPF: n = 30; EHF: n = 30), 37 (62%) received predominantly breast milk, and 23 (38%) received ≥75% study formula intake (IPF: n = 11; EHF: n = 12). No group differences were detected in tolerance measures. No necrotizing enterocolitis (NEC) was reported. Median time to achievement of full enteral feeding was significantly shorter for the IPF vs. EHF group (day 10 vs. 14, p < 0.05) (subset analysis). Mean enteral intake significantly increased by day 14 for the IPF group (p < 0.05), reflecting group divergence as achieved feeding volumes increased. Conclusions: Results suggest shorter time to full enteral feeding and higher feeding volume achieved by study end in preterm infants receiving intact protein preterm formula versus extensively hydrolyzed formula.

scholarly journals Three-Hourly versus Two-Hourly Feeding Interval in Stable Preterm Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Jogender Kumar ◽  
Jitendra Meena ◽  
Pradeep Debata ◽  
Jeeva Mary Sankar ◽  
Praveen Kumar ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Preterm Infants ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Stage Ii ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Registration Number ◽  
Group 1

Abstract Evidence from randomized controlled trials (RCTs) suggests that three-hourly feeding is safe and might help achieve full feeds earlier in preterm infants. We systematically compared the benefits and harms of three-hourly and two-hourly feeding schedules in preterm infants. We searched electronic databases (MEDLINE, CINAHL, Embase, Web of Science, and Scopus) and trial registries until 30 July 2021 for RCTs comparing the two feeding schedules. We did random-effects meta-analysis using RevMan 5.4 software. The primary outcome was the incidence of stage II or III necrotizing enterocolitis (NEC). Other outcomes were the incidence of any stage NEC, sepsis, mortality, time to full enteral feeds, and hospital stay. Six trials (872 participants) are included. There was no significant difference in the incidence of stage II/III NEC (3 trials; 530 participants; RR 1.39; 95% CI: 0.53,3.65; I2 -0%, low certainty), and any stage NEC (5 studies; 767 participants; RR 0.98; 95% CI: 0.53,1.82; I2 0%, very-low certainty) between three and two-hourly feeding groups. There was no difference in the time to achieve full feeds (5 trials; 755 participants; MD: -0.0 days; 95% CI: -0.32, 0.31, low certainty) or other outcomes. On subgroup analysis, neonates with birthweight <1000 grams and in the three-hourly feeding regime achieved full enteral feeds slower than those in the two-hourly feeding group (1 trial; 84 participants; MD: 2.9 days, 95% CI: 1.16, 4.64, low certainty).ConclusionIn stable preterm infants (1000-1500 grams), three-hourly feeding can be followed safely. In infants <1000 grams, two-hourly feeding should be continued till further evidence.Prospero Registration Number: CRD42021246568

scholarly journals Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis

Nutrients ◽  
2016 ◽  
Vol 8 (8) ◽  
pp. 471 ◽  
Author(s):  
Arianna Aceti ◽  
Davide Gori ◽  
Giovanni Barone ◽  
Maria Callegari ◽  
Maria Fantini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Milk ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Meta Analysis ◽  
Full Enteral Feeding

scholarly journals Early progressive feeding in extremely preterm infants: a randomized trial

2018 ◽  
Vol 107 (3) ◽  
pp. 365-370 ◽  
Author(s):  
Ariel A Salas ◽  
Peng Li ◽  
Kelli Parks ◽  
Charitharth V Lal ◽  
Camilia R Martin ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Enteral Feeding ◽  
Primary Outcome ◽  
Central Venous Access ◽  
Venous Access ◽  
Feeding Group ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Postmenstrual Age ◽  
Full Enteral Feeding

ABSTRACT Background Due to insufficient evidence, extremely preterm infants (≤28 wk of gestation) rarely receive early progressive feeding (small increments of feeding volumes between 1 and 4 d after birth). We hypothesized that early progressive feeding increases the number of full enteral feeding days in the first month after birth. Objective The aim of this study was to determine the feasibility and efficacy of early progressive feeding in extremely preterm infants. Design In this single-center randomized trial, extremely preterm infants born between September 2016 and June 2017 were randomly assigned to receive either early progressive feeding without trophic feeding (early feeding group) or delayed progressive feeding after a 4-d course of trophic feeding (delayed feeding group). Treatment allocation occurred before or on feeding day 1. The primary outcome was the number of full enteral feeding days in the first month after birth. Secondary outcomes were death, necrotizing enterocolitis (NEC), culture-proven sepsis, growth percentiles at 36 wk postmenstrual age, use of parenteral nutrition, and need for central venous access. Results Sixty infants were included (median gestational age: 26 wk; mean ± SD birth weight: 832 ± 253 g). The primary outcome differed between groups (median difference favoring the early feeding group: +2 d; 95% CI: 0, 3 d; P = 0.02). Early progressive feeding reduced the use of parenteral nutrition (4 compared with 8 d; P ≤ 0.01) and the need for central venous access (9 compared with 13 d; P ≤ 0.01). The outcome of culture-proven sepsis (10% compared with 27%; P = 0.18), restricted growth (weight, length, and head circumference <10th percentile) at 36 wk postmenstrual age (25% compared with 50%; P = 0.07), and the composite outcome of NEC or death (27% compared with 20%; P = 0.74) did not differ between groups. Conclusion Early progressive feeding increases the number of full enteral feeding days in extremely preterm infants. This trial was registered at www.clinicaltrials.gov as NCT02915549.

scholarly journals Does full enteral feed from day one of life influence weight gain in hemodynamically stable VLBW babies weighing between 1000-1500 grams as against standard feeding? a randomized controlled trial

2020 ◽  
Vol 7 (4) ◽  
pp. 932
Author(s):  
Ramya S. Shanmugam ◽  
Mangala Bharathi ◽  
Kumutha Jayaraman
Keyword(s):  
Birth Weight ◽  
Human Milk ◽  
Enteral Feeding ◽  
Controlled Trial ◽  
Intravenous Fluid ◽  
Preterm Neonates ◽  
Intravenous Fluids ◽  
Randomized Controlled ◽  
Feeding Group ◽  
Full Enteral Feeding

Background: Preterm neonates post-natal growth should be similar to the intrauterine growth of the fetus of the same gestational age. This study aims to  evaluate the effects of full enteral feed (60 ml/kg/day of human milk on day one, 20ml/kg/day during feeding advancement) started from day one of life (intervention) in enhancing   the regain of birth weight compared to that of standard feed (both human milk feeds and intravenous fluid) in a group.Methods: Babies were started on enteral feeds with human milk at the rate of 60ml/kg/day from day one and progressed by increments of 20 ml/kg/day up to maximum enteral feed of 180 ml/kg/day. The primary outcomes like Number of days taken to regain the birth weight, Duration of hospital stay, Incidence of Necrotising Enterocolitis (NEC), Incidence of sepsis, need for intravenous fluid therapy was assessed and statically analysed.Results: Full enteral feeding group infants had lesser days of intravenous fluids. Full enteral feeding group regained birth weight at a mean age of 17.37±4.9 days and in the standard feeding group, birth weight was regained at a mean age of 19.8±4.3. Full enteral feeding group regained birth weight at a mean age of 13.12±2.17 days and in standard feeding group at a mean age of 15.38±3.57and this was statistically significant (p - 0.009). Full enteral feeding group babies had lesser number of days of intravenous fluids compared to babies in standard feeding group. It was statistically significant (p - 0.003).Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.

scholarly journals Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiao-Li Chen ◽  
Bei-Lei Zhang ◽  
Chang Meng ◽  
Hui-Bin Huang ◽  
Bin Du
Keyword(s):  
Sensitivity Analysis ◽  
Randomized Controlled Trials ◽  
Critically Ill Patients ◽  
Oxygen Therapy ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Icu Patients ◽  
Randomized Controlled

Abstract Objective Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients. Methods We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Results We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. Conclusions Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.

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