Early total enteral feeding in stable preterm infants: a systematic review and meta-analysis

OBJECTIVE: To evaluate safety and feasibility of early total enteral feeding (ETEF) in stable preterm infants. STUDY DESIGN: Systematic review and meta-analysis of randomized trials comparing incidence of necrotizing enterocolitis (NEC) and feeding intolerance between ETEF and slow rates of enteral feed advancement. RESULTS: Four trials involving 393 very low birth weight (VLBW) infants with birth weight >1000-1200 g were included. Meta-analyses did not show statistical difference in risks for NEC (RR 0.87, 95% CI 0.19-3.98) and feeding intolerance (RR 0.78, 95% CI 0.39-1.59). ETEF resulted in lower risk of late-onset sepsis (RR: 0.43, 95% CI: 0.30-0.61). Length of hospital stay was reduced in ETEF (mean difference -1.31 days, 95% CI: -1.54 to -1.07). CONCLUSIONS: ETEF appears to be safe and feasible in stable VLBW infants with birth weight >1000-1200 g. A large randomized trial is needed to confirm benefits.