Three-hourly versus two-hourly feeding interval in stable preterm infants: an updated systematic review and meta-analysis of randomized controlled trials

Jogender Kumar; Jitendra Meena; Pradeep Debata; MJeeva Sankar; Praveen Kumar; Arvind Shenoi

doi:10.1007/s00431-022-04405-y

Three-hourly versus two-hourly feeding interval in stable preterm infants: an updated systematic review and meta-analysis of randomized controlled trials

Eur J Pediatr. 2022 May;181(5):2075-2086. doi: 10.1007/s00431-022-04405-y. Epub 2022 Feb 11.

Authors

Jogender Kumar¹, Jitendra Meena¹, Pradeep Debata², MJeeva Sankar³, Praveen Kumar⁴, Arvind Shenoi⁵

Affiliations

¹ Department of Pediatrics, Neonatal Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012.
² Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
³ Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Pediatrics, Neonatal Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012. drpkumarpgi@gmail.com.
⁵ Department of Neonatology, Cloudnine Hospital, Bengaluru, Karnataka, India.

PMID: 35147747
DOI: 10.1007/s00431-022-04405-y

Abstract

Evidence from randomized controlled trials (RCTs) suggests that three-hourly feeding is safe and might help achieve full feeds earlier in preterm infants. We systematically compared the benefits and harms of three-hourly and two-hourly feeding schedules in preterm infants. We searched electronic databases (MEDLINE, CINAHL, Embase, Web of Science, and Scopus) and trial registries until November 16, 2021, for RCTs comparing the two feeding schedules. We did a random-effects meta-analysis using RevMan 5.4 software. The primary outcome was the incidence of stage II or III necrotizing enterocolitis (NEC). Other outcomes were the incidence of any stage NEC, mortality, time to full enteral feeds, and hospital stay. Six trials (872 participants) are included. There was no significant difference in the incidence of stage II/III NEC (3 trials; 530 participants; RR 1.39; 95% CI: 0.53, 3.65; I² - 0%, low certainty), and any stage NEC (5 studies; 767 participants; RR 0.98; 95% CI: 0.53, 1.82; I² -0%, very low certainty) between three and two-hourly feeding groups. There was no difference in achieving full feeds (5 trials; 755 participants; MD: - 0.0 days; 95% CI: - 0.32, 0.31, low certainty) or other outcomes. On subgroup analysis, neonates with birthweight < 1000 g and in the three-hourly feeding regime achieved full enteral feeds slower than those in the two-hourly feeding group (1 trial; 84 participants; MD: 2.9 days, 95% CI: 1.16, 4.64, low certainty).

Conclusion: In stable preterm infants (1000-1500 g), three-hourly feeding can be followed safely. In infants < 1000 g, there is insufficient evidence to advise on an optimal feeding interval, although a 2-h interval might be preferable.Prospero Registration Number: CRD42021246568.

What is known: • Most of the units follow two-hourly feeding schedules without any evidence. • Recent trials suggest that the three hourly feeding schedules can be safely followed in stable preterm infants.

What is new: • Low certainty evidence suggests that three-hourly feeding is safe in stable preterm infants (1000-1500 grams). • In infants with birthweight <1000 grams, two-hourly feeding may be considered as it was associated with a shorter time to full feeds in subgroup analysis.

Keywords: Feed intolerance; Infants; Necrotizing enterocolitis; Nutrition; Small for gestational age.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Birth Weight
Enteral Nutrition
Enterocolitis, Necrotizing* / epidemiology
Humans
Infant
Infant, Newborn
Infant, Premature*
Randomized Controlled Trials as Topic