Responsive Feeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis

Abstract

BACKGROUND AND OBJECTIVES Responsive feeding may improve health outcomes in preterm and low birth weight (LBW) infants. Our objective was to assess effects of responsive compared with scheduled feeding in preterm and LBW infants. METHODS Data sources include PubMed, Scopus, Web of Science, CINAHL, LILACS, and MEDICUS. Randomized trials were screened. Primary outcomes were mortality, morbidity, growth, neurodevelopment. Secondary outcomes were feed intolerance and duration of hospitalization. Data were extracted and pooled with random-effects models. RESULTS Eleven eligible studies were identified, and data from 8 randomized control trials with 455 participants were pooled in the meta-analyses. At discharge, the mean difference in body weight between the intervention (responsive feeding) and comparison (scheduled feeding) was −2.80 g per day (95% CI −3.39 to −2.22, I2 = 0%, low certainty evidence, 4 trials, 213 participants); −0.99 g/kg per day (95% CI −2.45 to 0.46, I2 = 74%, very low certainty evidence, 5 trials, 372 participants); −22.21 g (95% CI −130.63 to 86.21, I2 = 41%, low certainty evidence, 3 trials, 183 participants). The mean difference in duration of hospitalization was −1.42 days (95% CI −5.43 to 2.59, I2 = 88%, very low certainty evidence, 5 trials, 342 participants). There were no trials assessing other growth outcomes (eg, length and head circumference) mortality, morbidity or neurodevelopment. Limitations include a high risk of bias, heterogeneity, and small sample size in included studies. CONCLUSIONS Overall, responsive feeding may decrease in-hospital weight gain. Although the evidence is very uncertain, responsive feeding may slightly decrease the duration of hospitalization. Evidence was insufficient to understand the effects of responsive compared with scheduled feeding on mortality, morbidity, linear growth, and neurodevelopmental outcomes in preterm and LBW infants.

New World Health Organization recommendations for care of preterm or low birth weight infants: health policy

“…This decision was informed by evidence of small benefits from responsive feeding on decreased length of hospital stay (very low certainty) but also small harms from responsive feeding on decreased weight gain until discharge (low certainty). 23 The trials included in the review used various feeding schedules; the GDG suggested that 2–3 hourly scheduled feedings may be used, as this is a commonly used and feasible schedule. A recommendation could not be made on feeding after hospital discharge.…”

“…Seventeen new systematic reviews were commissioned to assess topics not addressed in existing reviews and 21 additional existing systematic reviews and meta analyses were assessed by the GDG ( Supplementary Table S2 ). 7 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 The quality of the scientific evidence for each intervention was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE), 40 and evidence was categorised as high, moderate, low and very low certainty. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) 41 approach was used for qualitative evidence.…”