High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

Thangaraj Abiramalatha; Niranjan Thomas; Vijay Gupta; Anand Viswanathan; William McGuire

doi:10.1002/14651858.CD012413.pub2

Cochrane Database of Systematic Reviews

High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

Information

DOI:

https://doi.org/10.1002/14651858.CD012413.pub2 Copy DOI

Database:

Cochrane Database of Systematic Reviews

Version published:

12 September 2017see what's new

Type:

Intervention

Stage:

Review

Cochrane Editorial Group:

Cochrane Neonatal Group

Copyright:

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

Thangaraj Abiramalatha

Correspondence to: Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India

[email protected]
Niranjan Thomas

Neonatology, Christian Medical College, Vellore, India
Vijay Gupta

Neonatology, Christian Medical College, Vellore, India
Anand Viswanathan

Cochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health Policy, Christian Medical College, Vellore, India
William McGuire

Centre for Reviews and Dissemination, The University of York, York, UK

Contributions of authors

All review authors developed the protocol. TA and WM screened search outputs, assessed study eligibility, and extracted and synthesised data. TA and VA assessed risk of bias across key domains and undertook GRADE assessment with WM. All review authors revised the final review.

Sources of support

Internal sources

University of York, UK.
Christian Medical College, Vellore, India.
Sri Ramachandra Medical College and Research Institute, Chennai, India.

External sources

National Institute for Health Research, UK.

This report is independent research funded by a UK National Institute of Health Research Grant (NIHR) Cochrane Programme Grant (13/89/12). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA.

Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201600005C.

Declarations of interest

Dr. Thomas was the principal investigator in the only study included in the review (Thomas 2012).

Acknowledgements

None.

Version history

Published

Title

Stage

Authors

Version

2021 Mar 12

High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

Review

Thangaraj Abiramalatha, Niranjan Thomas, Sivam Thanigainathan

https://doi.org/10.1002/14651858.CD012413.pub3

2017 Sep 12

High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

Review

Thangaraj Abiramalatha, Niranjan Thomas, Vijay Gupta, Anand Viswanathan, William McGuire

https://doi.org/10.1002/14651858.CD012413.pub2

2016 Oct 21

High versus standard volumes of enteral feeds for preterm or low birth weight infants

Protocol

Thangaraj Abiramalatha, Niranjan Thomas, Vijay Gupta, Anand Viswanathan, William McGuire

https://doi.org/10.1002/14651858.CD012413

Differences between protocol and review

None.

PICOs

Population

Intervention

Comparison

Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Figure 1

Study flow diagram.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for the included study.

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Figure 3

Forest plot of comparison: 1 High‐volume vs standard‐volume feeds, outcome: 1.1 Weight gain (g/kg/d).

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Figure 4

Forest plot of comparison: 1 High‐volume vs standard‐volume feeds, outcome: 1.2 Feed intolerance.

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Figure 5

Forest plot of comparison: 1 High‐volume vs standard‐volume feeds, outcome: 1.3 Necrotising enterocolitis.

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Analysis 1.1

Comparison 1 High‐volume vs standard‐volume feeds, Outcome 1 Weight gain (g/kg/d).

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Analysis 1.2

Comparison 1 High‐volume vs standard‐volume feeds, Outcome 2 Feed intolerance.

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Analysis 1.3

Comparison 1 High‐volume vs standard‐volume feeds, Outcome 3 Necrotising enterocolitis.

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Summary of findings for the main comparison. High‐volume feeds vs standard‐volume feeds for preterm or low birth weight infants

High‐volume feeds vs standard‐volume feeds for preterm or low birth weight infants
Patient or population: preterm or low birth weight infants Setting: neonatal care facilities Intervention: high‐volume feeds Comparison: standard‐volume feeds
Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)
	Risk with standard‐volume feeds	Risk with high‐volume feeds
Weight gain (g/kg/d)	Mean weight gain was 18.7 g/kg/d	Mean weight gain was 6.2 g/kg/d higher (2.71 higher to 9.69 higher)	‐	61 (1 RCT)	⊕⊕⊝⊝ LOW^a,b
Feed intolerance	Study population		RR 1.81 (0.89 to 3.67)	61 (1 RCT)	⊕⊕⊝⊝ LOW^a,b
	258 per 1000	467 per 1000 (230 to 947)
Necrotising enterocolitis	Study population		RR 1.03 (0.07 to 15.78)	61 (1 RCT)	⊕⊝⊝⊝ VERY LOW^a,c
	32 per 1000	33 per 1000 (2 to 509)
*Risk in the intervention group (and its 95% CI) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.
^aDowngraded for risk of bias (lack of blinding). ^bDowngraded for imprecision. ^cDowngraded (by 2) for serious imprecision.

Summary of findings for the main comparison. High‐volume feeds vs standard‐volume feeds for preterm or low birth weight infants

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Table 1. Typical energy and protein content of human milk or formula

per 100 mL

Expressed breast milk

(EBM)

EBM

+ Fortifier

Term formula

Preterm formula

Energy (kCal)

67

74 to 80

67

80

Protein (g)

1.2 to 1.7

2.0 to 2.5

1.5

2.4

Table 1. Typical energy and protein content of human milk or formula

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Comparison 1. High‐volume vs standard‐volume feeds

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Weight gain (g/kg/d) Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	6.20 [2.71, 9.69]

2 Feed intolerance Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.81 [0.89, 3.67]

3 Necrotising enterocolitis Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.07, 15.78]

Comparison 1. High‐volume vs standard‐volume feeds

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High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants

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