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Study flow diagram (2016).
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Figure 1

Study flow diagram (2016).

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

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

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Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 1 Weight (g).
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Analysis 1.1

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 1 Weight (g).

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Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 2 Length (cm).
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Analysis 1.2

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 2 Length (cm).

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Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 3 Head circumference (cm).
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Analysis 1.3

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 3 Head circumference (cm).

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Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 4 Serum alkaline phosphatase.
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Analysis 1.4

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 4 Serum alkaline phosphatase.

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Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 5 Osteopenia.
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Analysis 1.5

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 5 Osteopenia.

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Summary of findings for the main comparison. Calcium supplementation compared with no calcium supplementation for preterm infants

Calcium supplementation compared with no calcium supplementation for preterm infants

Patient or population: preterm hospitalised infants
Setting: hospital setting
Intervention: calcium and/or phosphorus supplementation
Comparison: no supplement

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no calcium/phosphorus supplementation

Risk with calcium/phosphorus supplementation

Weight (g) ‐ weight at 6 weeks

Mean weight (g) ‐ weight at 6 weeks was 2483 g

MD 138.5 g higher
(82.16 lower to 359.16 higher)

‐

40
(1 RCT)

⊕⊕⊝⊝
Lowa,b

Length (cm) ‐ length at 6 weeks

Mean length (cm) ‐ length at 6 weeks was 47.04 cm

MD 0.77 cm higher
(0.93 lower to 2.47 higher)

‐

40
(1 RCT)

⊕⊕⊝⊝
Lowa,c

Head circumference (cm) ‐ head circumference at 6 weeks

Mean head circumference (cm) ‐ head circumference at 6 weeks was 34.31 cm

MD 0.33 cm higher
(0.3 lower to 0.96 higher)

‐

40
(1 RCT)

⊕⊕⊝⊝
Lowa,c

Bone fracture (neonatal) ‐ not measured

‐

‐

‐

‐

‐

This was not a prespecified outcome; included study did not report this outcome

Growth (childhood/adulthood) ‐ not measured

‐

‐

‐

‐

‐

Included study provided no follow‐up into childhood

Bone mineral density (infant/childhood/adulthood) ‐ not measured

‐

‐

‐

‐

‐

Included study provided no follow‐up into childhood

Fracture (childhood/adulthood) ‐ not measured

‐

‐

‐

‐

‐

Included study provided no follow‐up into childhood

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: confidence interval; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aRisk of bias: insufficient evidence to judge methods of randomisation, allocation concealment or blinding of personnel ‐ downgraded one level

bImprecision: wide confidence intervals and data from a single small study ‐ downgraded one level

cImprecision: evidence from a single small study ‐ downgraded one level

Figuras y tablas -
Summary of findings for the main comparison. Calcium supplementation compared with no calcium supplementation for preterm infants
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Comparison 1. Calcium supplementation versus no calcium supplementation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight (g) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Weight at 2 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

52.5 [‐155.44, 260.44]

1.2 Weight at 4 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

60.00 [‐151.39, 271.39]

1.3 Weight at 6 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

138.5 [‐82.16, 359.16]

2 Length (cm) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Length at 2 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

0.34 [‐1.36, 2.04]

2.2 Length at 4 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

0.47 [‐1.20, 2.14]

2.3 Length at 6 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

0.77 [‐0.93, 2.47]

3 Head circumference (cm) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 Head circumference at 2 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

0.19 [‐0.42, 0.80]

3.2 Head circumference at 4 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

0.22 [‐0.39, 0.83]

3.3 Head circumference at 6 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

0.33 [‐0.30, 0.96]

4 Serum alkaline phosphatase Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Serum ALP at 2 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

‐36.35 [‐91.14, 18.44]

4.2 Serum ALP at 4 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

‐34.90 [‐81.23, 11.43]

4.3 Serum ALP at 6 weeks

1

40

Mean Difference (IV, Fixed, 95% CI)

‐56.85 [‐101.27, ‐12.43]

5 Osteopenia Show forest plot

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.33, 1.15]
Figuras y tablas -
Comparison 1. Calcium supplementation versus no calcium supplementation
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