Am J Perinatol 2020; 37(09): 898-906
DOI: 10.1055/s-0039-1691767
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Two-Hourly versus Three-Hourly Feeding in Very Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

1  Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
2  Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations
Funding None.
Further Information

Publication History

22 December 2018

11 April 2019

Publication Date:
04 June 2019 (online)


Objective This study aimed to systematically review and meta-analyze the benefits and side effects of 3-hourly versus 2-hourly feeding intervals in very low-birth-weight (VLBW) infants.

Study Design Database search include PubMed and Cochrane CENTRAL databases from inception until March 3, 2019. The author extracted the data from included studies and used Cochrane-GRADE approach to assess the quality of the evidence.

Results Seven studies—four randomized controlled trials (RCTs) and three observational studies—involving 952 infants were included in the review. The pooled analyses of RCTs showed no significant differences in the outcomes: time to reach full enteral feeding, necrotizing enterocolitis, feed intolerance, and hypoglycemia. Infants fed 3-hourly regain birth weight earlier than infants fed 2-hourly (3 RCTs; 350 participants; mean difference [95% confidence interval] −1.12 [−2.16 to −0.08]; I2 = 0%; p = 0.04). The evidence was downgraded to low quality due to risk of bias and imprecision for all outcomes. Two studies found a subgroup of infants, younger and smaller, reach full enteral feeds earlier when fed 2-hourly compared with 3-hourly.

Conclusion Low-quality evidence suggests feeding 3-hourly is comparable to 2-hourly feeding in VLBW infants. However, extremely low-birth-weight infants reach full enteral feeds earlier when fed 2-hourly compared with 3-hourly. Further, sufficient powered trials are needed.

Author's Contributions

A.R. solely conceptualized and designed the study, performed the search and initial screening of the articles, abstracted the data, performed initial analyses and assessed the risk of bias, graded of quality of evidence, drafted the manuscript, and approved the final version.

Supplementary Material