Background Optimal feeding of very low birthweight (VLBW <1500 g)/very preterm (gestation <32 weeks) infants in resource-limited settings in sub-Saharan Africa (sSA) is critical to reducing high mortality and poor outcomes.
Objective To review evidence on feeding of VLBW/very preterm infants relevant to sSA.
Methods We searched the Cochrane Database of Systematic Reviews, Embase, PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to July 2019 to identify reviews of randomised and quasi-randomised controlled trials of feeding VLBW/very preterm infants. We focused on interventions that are readily available in sSA. Primary outcomes were weight gain during hospital stay and time to achieve full enteral feeds (120 mL/kg/day). Secondary outcomes were growth, common morbidities, mortality, duration of hospital stay and cognitive development. Quality of evidence (QOE) was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR2).
Results Eight systematic reviews were included. Higher feed volume of day 1 (80 mL/kg) reduced late-onset sepsis and time to full enteral feeds, and higher feed volume (up to 300 mL/kg/day) improved weight gain without adverse events (QOE: low–moderate). Rapid advancement of feeds (30–40 mL/kg/day) was not associated with harm. Breast milk fortification with energy and protein increased growth and with prebiotics increased growth and reduced duration of admission (QOE: low–very low) and did not result in harm. Evidence regarding feeding tube placement and continuous versus bolus feeds was insufficient to draw conclusions. We found no reviews meeting our selection criteria regarding when to start feeds, use of preterm formula, cup-and-spoon feeding or gravity versus push feeds and none of the reviews included trials from low-income countries of sSA.
Conclusions The evidence base informing feeding of VLBW/very preterm babies in resource-limited settings in sSA is extremely limited. Pragmatic studies are needed to generate evidence to guide management and improve outcomes for these highly vulnerable infants.
PROSPERO registration number CRD42019140204.
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AA and AT are joint first authors.
Correction notice This article has been corrected since it was published. One of the author's name in the Collaborators section has been corrected.
Collaborators Neonatal Nutrition Network members: Olusegun Akinyinka (College of Medicine, University of Ibadan, Nigeria); Dominic D Umoru (Maitama District Hospital, Abuja, Nigeria); Chinyere Ezeaka (Lagos University Teaching Hospital, Nigeria); Beatrice N Ezenwa (Lagos University Teaching Hospital, Nigeria); Iretiola B Fajolu (Lagos University Teaching Hospital, Nigeria); Zainab O Imam (Massey St. Children’s Hospital, Lagos, Nigeria); Martha K Mwangome (KEMRI Wellcome Trust Research Programme, Kilifi, Kenya); Alison W Talbert (KEMRI Wellcome Trust Research Programme, Kilifi, Kenya); Pauline EA Andang’o (Maseno University, Kenya); Walter Otieno (Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya & Maseno University, Kenya); Grace M Nalwa (Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya & Maseno University, Kenya); Ian Sinha (Alder Hey Children’s Hospital, Liverpool, UK); Janneke van de Wijgert (University of Liverpool, Liverpool, UK); Melissa Gladstone (University of Liverpool, Liverpool, UK); Kevin Mortimer (Liverpool School of Tropical Medicine, Liverpool, UK); Graham Devereux (Liverpool School of Tropical Medicine, Liverpool, UK); Ismaela Abubakar (Liverpool School of Tropical Medicine, Liverpool, UK); Stephen Turner (University of Aberdeen, Aberdeen, UK); Nicholas Embleton (Newcastle University, Newcastle, UK); Helen M Nabwera (Liverpool School of Tropical Medicine, Liverpool, UK); Stephen J Allen (Liverpool School of Tropical Medicine, Liverpool, UK); Isa Abdulkadir (Ahmadu Bello University, Zaria, Nigeria); Olukemi O Tongo (College of Medicine, University of Ibadan, Nigeria); Abimbola E Akindolire (College of Medicine, University of Ibadan, Nigeria).
Contributors AA conceived the study, undertook the literature search, selected reviews, extracted data and wrote the first draft of the manuscript. AT conceived the study, undertook the literature search, selected reviews, checked extracted data and wrote the first draft of the manuscript. SA conceived the study, arbitrated on selection of reviews and revised the manuscript. IS and NE advised on design of the study and revised the manuscript. All authors read and approved the final manuscript.
Funding This overview is supported by an MRC Confidence in Global Nutrition and Health Research Initiative grant: improving the survival, growth and development of low birthweight newborns through better nutrition (Reference: MC_PC_MR/R019789/1).
Competing interests NE reports grants from Prolacta Biosciences US, grants from Danone Early Life Nutrition, personal fees from Nestle Nutrition Institute, outside the submitted work.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. Our review analysed summary deidentified patient data from published reviews. Data availability is through the original authors of the published reviews.