Nutrition guidelines for preterm infants: A systematic review

Abstract

Background:There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation. We aimed to assess the quality of nutritional guidelines for preterm infants, the consistency of recommendations, and the gaps in recommendations.Methods:We searched databases and websites for nutritional guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorised by a regional, national, or international body, written in English, and published between 2012‐2023. Two reviewers independently screened articles and extracted the recommendations. Four reviewers appraised the included guidelines using AGREE II.Results:7051 records were identified, and 27 guidelines included, 26% of which were high in quality. Most guidelines lacked stakeholder involvement and rigour of development. We found considerable variation in recommendations, many of which lacked details of certainty of evidence and strength of recommendation. Recommendations for type of feed and breastmilk fortification were consistent among high quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutritional adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to very low certainty of evidence.Conclusions:Future development of nutritional guidelines for preterm infants should follow the standard guideline development method and ensure the rigorous process including stakeholders involvement to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.This article is protected by copyright. All rights reserved.