Two-Hourly versus Three-Hourly Feeding in Very Low-Birth-Weight Infants: A Systematic Review and Meta-AnalysisFunding None.
22 December 2018
11 April 2019
04 June 2019 (eFirst)
Objective 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.
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.
- 1 Newell SJ. Gastrointestinal function and its ontogeny: how should we feed the preterm infant?. Semin Neonatol 1996; 1 (01) 59-66
- 2 Dhingra A, Agrawal SK, Kumar P, Narang A. A randomised controlled trial of two feeding schedules in neonates weighing <or=1750 g. J Matern Fetal Neonatal Med 2009; 22 (03) 198-203
- 3 Ibrahim NR, Kheng TH, Nasir A. , et al. Two-hourly versus 3-hourly feeding for very low birthweight infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2017; 102 (03) F225-F229
- 4 DeMauro SB, Abbasi S, Lorch S. The impact of feeding interval on feeding outcomes in very low birth-weight infants. J Perinatol 2011; 31 (07) 481-486
- 5 Welch V, Petticrew M, Petkovic J. , et al; PRISMA-Equity Bellagio group. Extending the PRISMA statement to equity-focused systematic reviews (PRISMA-E 2012): explanation and elaboration. Int J Equity Health 2015; 14 (01) 92
- 6 The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed May 2019
- 7 The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed May 2019
- 8 Schunemann HBrozek J, Guyatt G, Oxman A. , eds. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. London, UK: Cochrane; 2015
- 9 Rüdiger M, Herrmann S, Schmalisch G, Wauer RR, Hammer H, Tschirch E. Comparison of 2-h versus 3-h enteral feeding in extremely low birth weight infants, commencing after birth. Acta Paediatr 2008; 97 (06) 764-769
- 10 Tali SH, Kabra NS, Ahmed J. , et al. Effect of feeding schedule on time to reach full feeds in ELBW and VLBW neonates: a randomized trial. Perinatology-Journal of Perinatal and Neonatal Care 2016; 17 (03) 95-102
- 11 Anushree N, Shaw S, Negi V. 2 hourly versus 3 hourly feeding schedule in very low birth weight preterm neonates. Journal of Marine Medical Society. 2018; 20 (02) 96-99
- 12 Chu E, Freck S, Zhang L, Bhakta KY, Mikhael M. Three-hourly feeding intervals are associated with faster advancement in very preterm infants. Early Hum Dev 2019; 131: 1-5
- 13 Binchy Á, Moore Z, Patton D. Feeding intervals in premature infants ≤1750 g: an integrative review. Adv Neonatal Care 2018; 18 (03) 168-178
- 14 Ibrahim NR, Van Rostenberghe H, Ho JJ. Short versus long feeding interval for bolus feedings in very preterm infants. Cochrane Database Syst Rev 2016; (08) 1-10