Table 2

Findings from systematic reviews

Review/outcomeNo 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 NEC1 (64)RR 1.03 (0.07 to 15.78)Very low
Feed intolerance1 (64)RR 1.81 (0.89 to 3.67)Low
Mortality1 (64)No death in any groupNR
Oddie et al22: slow versus faster rate or few advancement
Weight gain at discharge1 (2804)MD 0.0 (−0.08 to 0.08)NR
Time to full feeds8 (3551)Longer time in slow advancement group. CI NRNR
Gain in Head Circumference (HC) z score at discharge1 (2804)MD 0.0 (−0.13 to 0.13)NR
Frequency of NEC10 (3738)RR 1.07 (CI 0.83 to 1.39)Moderate
Frequency of sepsis8 (3391)RR 1.15 (1.00 to 1.32)Low
Duration of hospital stay in days2 trials reported longer duration in slow advancement groupNR
Mortality9 (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 weight2 (149)MD −1.15 days (−1.86 to −0.45)Moderate (Jadad score)
Feed intolerance3 (347)RR 0.78 (0.38 to 1.59)Moderate (Jadad score)
Time to full enteral feeds2 (164)MD −1.01 days (−1.36 to −0.66)Moderate (Jadad score)
Frequency of NEC4 (393)RR 0.87 (0.19 to 3.98)Moderate (Jadad score)
Incidence of late onset sepsis3 (290)RR 0.43 (0.30 to 0.61)Moderate (Jadad score)
Duration of hospital stay4 (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 NEC7 (539)RR 1.19 (0.49 to 2.88)Low
Feed intolerance5 (255)RR 0.90 (0.54 to 1.49)Low
Duration of hospital stay in weeks2 (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 intolerance1 (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 NEC1 (75)RR 0.2 (0.02 to 1.3)Very low
Duration of hospital stay in days1 (75)Median (range) supplement versus control: 16 (9 to 45) versus 25 (11 to 80) p=0.004Very low
3. How to feed
Watson and McGuire27: nasal versus oral placement of feeding tube
Time to regain birth weight in days1 (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 days3 (206)MD −0.31 (−1.65 to 1.03)NR
Time to full feeds in days4 (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 NEC4 (270)RR 2.23 (0.58 to 8.57)NR
Duration of hospital stay in days1 (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.