Findings from systematic reviews
| Review/outcome | No of studies (no of babies) | Results MD or RR (95% CI) | Quality of evidence (GRADE assessment) |
| 1. How to advance feeds | |||
| Abiramalatha et al24: high volume versus standard volume feeds | |||
| Weight gain (g/kg/day) | 1 (64) | MD 6.2 (2.71 to 9.69) | Low |
| Frequency of NEC | 1 (64) | RR 1.03 (0.07 to 15.78) | Very low |
| Feed intolerance | 1 (64) | RR 1.81 (0.89 to 3.67) | Low |
| Mortality | 1 (64) | No death in any group | NR |
| Oddie et al22: slow versus faster rate or few advancement | |||
| Weight gain at discharge | 1 (2804) | MD 0.0 (−0.08 to 0.08) | NR |
| Time to full feeds | 8 (3551) | Longer time in slow advancement group. CI NR | NR |
| Gain in Head Circumference (HC) z score at discharge | 1 (2804) | MD 0.0 (−0.13 to 0.13) | NR |
| Frequency of NEC | 10 (3738) | RR 1.07 (CI 0.83 to 1.39) | Moderate |
| Frequency of sepsis | 8 (3391) | RR 1.15 (1.00 to 1.32) | Low |
| Duration of hospital stay in days | 2 trials reported longer duration in slow advancement group | NR | |
| Mortality | 9 (3553) | RR 1.15 (0.93 to 1.42) | Moderate |
| Alshaikh et al23: early total enteral feeds versus early partial enteral feeds | |||
| Time to regain birth weight | 2 (149) | MD −1.15 days (−1.86 to −0.45) | Moderate (Jadad score) |
| Feed intolerance | 3 (347) | RR 0.78 (0.38 to 1.59) | Moderate (Jadad score) |
| Time to full enteral feeds | 2 (164) | MD −1.01 days (−1.36 to −0.66) | Moderate (Jadad score) |
| Frequency of NEC | 4 (393) | RR 0.87 (0.19 to 3.98) | Moderate (Jadad score) |
| Incidence of late onset sepsis | 3 (290) | RR 0.43 (0.30 to 0.61) | Moderate (Jadad score) |
| Duration of hospital stay | 4 (393) | MD −1.35 days (−2.57 to −0.13) | Moderate (Jadad score) |
| 2. What to feed | |||
| Brown et al20: breast milk fortified with carbohydrate, fat and protein versus unfortified breast milk | |||
| Weight gain (g/kg/day) | 5 (269) | MD 2.82 (1.83 to 3.80) | Low |
| Gain in length (cm/wk) | 3 (189) | MD 0.21 (0.14 to 0.28) | Low |
| Gain in HC (cm/wk) | 3 (189) | MD 0.11 (0.05 to 0.17) | Moderate |
| Frequency of NEC | 7 (539) | RR 1.19 (0.49 to 2.88) | Low |
| Feed intolerance | 5 (255) | RR 0.90 (0.54 to 1.49) | Low |
| Duration of hospital stay in weeks | 2 (210) | MD 0.38 (−0.16 to 0.93) | Low |
| Amissah et al25: breast milk supplemented with fat versus unsupplemented breast milk | |||
| Weight gain (g/kg/day) | 1 (14) | MD 0.60 (−2.4 to 3.6) | Very low |
| Length gain (cm/wk) | 1 (14) | MD 0.10 (−0.08 to 0.3) | Very low |
| Head circumference gain (cm/wk) | 1 (14) | MD 0.2 (−0.07 to 0.4) | Very low |
| Feed intolerance | 1 (16) | RR 3.0 (0.1 to 64.3) | Very low |
| Amissah et al26: breast milk supplemented with prebiotic carbohydrate versus unsupplemented breast milk | |||
| Weight gain at age 30 days (g) | 1 (75) | MD 160.4 (12.4 to 308.4) | Very low |
| Frequency of NEC | 1 (75) | RR 0.2 (0.02 to 1.3) | Very low |
| Duration of hospital stay in days | 1 (75) | Median (range) supplement versus control: 16 (9 to 45) versus 25 (11 to 80) p=0.004 | Very low |
| 3. How to feed | |||
| Watson and McGuire27: nasal versus oral placement of feeding tube | |||
| Time to regain birth weight in days | 1 (46) | MD 0.90 (−1.27 to 3.07) | NR ‘Study underpowered to exclude modest but plausible effect sizes’ |
| Time to full feeds (days) | 1 (46) | MD −2.7 (−11.9 to 6.5) | NR |
| Premji and Chessell21: continuous nasogastric milk versus intermittent bolus feeds | |||
| Weight gain (g/wk) | 2 (106) | MD 6.27 (−1.28 to 13.81) | NR |
| Time to regain birth weight in days | 3 (206) | MD −0.31 (−1.65 to 1.03) | NR |
| Time to full feeds in days | 4 (229) | MD 1.82 (−0.44 to 4.08) | NR |
| Gain in length (cm/wk) | 3 (159) | MD 0.07 (−0.04 to 0.18) | NR |
| Gain in HC (cm/wk) | 2 (77) | MD −0.01 (−0.12 to 0.13) | NR |
| Frequency of proven NEC | 4 (270) | RR 2.23 (0.58 to 8.57) | NR |
| Duration of hospital stay in days | 1 (82) | MD −1.00 (−8.62 to 6.62) | NR |
GRADE, Grading of Recommendation Assessment Development and Evaluation; MD, mean difference; NEC, necrotising enterocolitis; NR, not reported.