Two-Hourly versus Three-Hourly Feeding in Very Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

Abdul Razak
American Journal of Perinatology 2019 June 4

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.

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