Feeding in Preterm Neonates With Antenatal Doppler Abnormalities: A Systematic Review and Meta-Analysis

Abstract

Objectives: In this systematic review and meta-analysis, we attempted to determine the most appropriate feed initiation and advancement practices in preterm neonates with antenatal Doppler abnormalities. Methods: We included randomized controlled trials comparing different feed initiation and advancement practices in neonates with antenatal Doppler abnormalities. The databases of PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar were searched on February 25, 2022. The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RevMan 5.4 was used for data analysis. Results: Of the 1499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% confidence interval (CI) 0.71–1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47–1.48; 5 studies, 642 participants). A trend was noted towards an increase in feeding intolerance (RR 1.23, 95% CI 0.98–1.56; 5 studies, 715 participants). There was a significant reduction in age at full enteral feeds, duration of total parental nutrition, and rates of hospital-acquired infections. Rapid feed advancement decreased the age at full enteral feeds without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant. Conclusion: There is low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.

Slow verses rapid advancement of enteral feed in preterm neonates of 28-34 weeks of gestational age with abnormal antenatal umbilical artery Doppler: A randomised controlled trial

“…Concerning birth weight, neonates with >1250g had lesser incidence of NEC in both slow and rapid feeding neonates (23.8% and 16.7%) compared to neonates with <1250g slow and rapid feeding neonates (55% and 53.3%) but this was not statistically significant indicating that birth weight did not have an impact with the incidence of NEC contrary to the study by Karagianni P, et al 9 . Rapid feeding was not associated with more NEC than delayed feeding in our study, similar to a systemic review and metanalysis 10 , The overall incidence of feed intolerance was 36% in our trial. We did not detect any significant difference between the groups whereas it was 28% in a study by Jain S, et al 6 and 45% in a study by Aaradhya AS, et al 11 .…”