Overview of Cochrane systematic reviews of early enteral feeding strategies for improving growth and reducing necrotising enterocolitis in very preterm or very low birth weight infants

Walsh, Verena

Abstract

Background:
Balancing nutrition for healthy growth and development of preterm infants while avoiding necrotising enterocolitis (NEC) and consequences of prolonged parenteral nutrition remains one of the greatest challenges in neonatal care. Early enteral nutrition is important for gastrointestinal maturation but is feared to create a physiological strain contributing to NEC. Despite vast research into best practice, large variations in feeding practices continue to exist.
Methods:
Using Cochrane methodology, we conducted a search for Cochrane systematic reviews evaluating the effects of early enteral feeding strategies on NEC and growth in very preterm or very low birth weight (VLBW) infants. Eligible reviews were assessed for certainty of the evidence and quality of the systematic review methodology, following which the certainty of the evidence base was summarised.
Results:
Review quality was generally high, however some methodological areas for improvement were highlighted. Of the thirty completed eligible reviews found, no interventions provided high certainty or probable evidence for improvement in short term growth while reducing or having no effect on NEC. The evidence base for long term growth was sparse. Only donor breast milk compared with formula was shown to be a promising intervention for reducing NEC, but probably harmful for short term growth. Probable evidence for no effect of different rates of feed advancement was concluded for both outcomes.
Conclusion:
Evidence for effects of many common early enteral feeding interventions on growth and NEC is uncertain. Investigation of NEC requires large improvements focussing on precision of the effect estimate and reducing risk of performance and detection bias. Evidence for growth would benefit from consistency in measurements between trials. Future trials should focus on infants at greatest risk of necrotising enterocolitis and subsequent feeding of infants affected by this early in their stay.

Citation

Walsh, V. (2021). Overview of Cochrane systematic reviews of early enteral feeding strategies for improving growth and reducing necrotising enterocolitis in very preterm or very low birth weight infants. (Thesis). Hull York Medical School, the University of Hull and the University of York. Retrieved from https://hull-repository.worktribe.com/output/4223645

• Thesis Type: Thesis
• Deposit Date: Nov 24, 2021
• Publicly Available Date: Feb 24, 2023
• Keywords: Medicine
• Public URL: https://hull-repository.worktribe.com/output/4223645
• Additional Information: Hull York Medical School, The University of Hull and the University of York
• Award Date: Mar 1, 2021