Three-hourly feeding intervals are associated with faster advancement in very preterm infants

Chu, Elaine; Freck, Sue; Zhang, Lishi; Bhakta, Kushal Y.; Mikhael, Michel

doi:10.1016/j.earlhumdev.2019.01.021

Cited by 7 publications

(7 citation statements)

References 26 publications

(45 reference statements)

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“…Seven studies were included in the qualitative analysis. [2][3][4][9][10][11][12] The list of studies excluded following a detailed review, including the reasons for exclusion, are provided in ►Supplementary Material B (available in the online version). Of the seven studies included, four were RCTs 2,3,10,11 and three were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…Of the seven studies included, four were RCTs 2,3,10,11 and three were retrospective cohort studies. 4,9,12 The risk of bias for observational studies is presented in ►Table 1 and that for RCTs in ►Fig. 2.…”

Section: Resultsmentioning

confidence: 99%

“…No differences were identified between the groups in the observational studies for the evaluated outcomes except time to reach full enteral feeding in one observational study. 12 One observational study identifies significant differences in the subgroup analysis. 4 Infants <28 weeks' gestational age (GA), and fed 2-hourly reach full feeds earlier than infants fed 3-hourly; however, no differences were noted for older infants >30-32 weeks (►Table 1).…”

Section: Meta-analysis Of Observational Studiesmentioning

confidence: 99%

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

Razak

2019

Am J Perinatol

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Objective This study aimed 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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Meta-analysis Of Observational Studiesmentioning

confidence: 99%

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

Razak

2019

Am J Perinatol

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“…A three-hourly feeding schedule can overcome the problems of both mothers and nurses, and potentially offer an advantage of faster feed advancement. 10 Physiological studies indicate that increasing the feeding interval to 3 hours may lead to better gastric emptying and less risk of feed intolerance. 1 2 However, three-hourly feeding regimes are not commonly practised in preterm infants, due to concerns about hypoglycaemia and feed intolerance.…”

Section: Available Knowledge and Rationalementioning

confidence: 99%

Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue

et al. 2021

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BackgroundA three-hourly feeding schedule has been shown to be as safe as a two-hourly schedule in preterm neonates. It saves nursing time and may be less tiring for the mothers. However, tradition and apprehensions have prevented its wider acceptance. We used a quality improvement approach to implement a three-hourly feeding schedule in stable preterm infants >32 weeks postmenstrual age (PMA) in our unit through a series of plan–do–study–act (PDSA) cycles.MethodsAll preterm neonates >32 weeks PMA, who were on full enteral feeds and without any respiratory support were eligible. The key quantitative outcome was maternal fatigue score. Safety was assessed in terms of episodes of hypoglycaemia and feed intolerance. Qualitative experiences from nursing staff were captured. The volume of expressed breastmilk and requirement of formula feeds were also recorded. After recording baseline data on a two-hourly feeding schedule, four PDSA cycles were sequentially completed over 21 weeks. The results of each PDSA cycle informed the change strategy for the next cycle.ResultsIn the baseline phase, five neonates on a two-hourly schedule were studied. In PDSA cycles I, II, III and IV, a cumulative of 122 neonates were studied on a three-hourly schedule. There was a significant decrease in median maternal fatigue score (13 (IQR 8–23) to 3 (IQR 1–6); p=0.01)). Only one neonate had feed intolerance, while two had mild asymptomatic transient hypoglycaemia. Six (5%) neonates were shifted to two-hourly feeds temporarily due to transient reasons. Nursing staff felt mothers could devote more time to Kangaroo mother care. The volume of expressed breastmilk and requirement of formula feeds were not different from the three-hourly schedule.ConclusionsIt was possible to change the traditional two-hourly feeding schedule to three-hourly in stable preterm infants using a quality improvement approach, while objectively documenting its safety and benefits.

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“…Due to the lack of scienti c basis for a two-hourly feeding schedule and perceived advantages of extended feeding schedules, three hourly feedings have been used successfully without any adverse effects [6][7][8]. Some studies observed that three hourly feeding schedules might help achieve full enteral feeds earlier, therefore, decreasing the duration of parenteral nutrition and central venous catheter [6]. A previous systematic review concluded that low-quality evidence shows that the three-hourly feeding schedule is safe and helps regain birth weight earlier than a 2-hourly feeding schedule [9].…”

Section: Introductionmentioning

confidence: 99%

Three-hourly versus two-hourly feeding interval in stable preterm infants: an updated systematic review and meta-analysis of randomized controlled trials

et al. 2022

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Evidence from randomized controlled trials (RCTs) suggests that three-hourly feeding is safe and might help achieve full feeds earlier in preterm infants. We systematically compared the bene ts and harms of three-hourly and two-hourly feeding schedules in preterm infants. We searched electronic databases (MEDLINE, CINAHL, Embase, Web of Science, and Scopus) and trial registries until 30 July 2021 for RCTs comparing the two feeding schedules. We did random-effects meta-analysis using RevMan 5.4 software. The primary outcome was the incidence of stage II or III necrotizing enterocolitis (NEC). Other outcomes were the incidence of any stage NEC, sepsis, mortality, time to full enteral feeds, and hospital stay. Six trials (872 participants) are included. There was no signi cant difference in the incidence of stage II/III NEC (3 trials; 530 participants; RR 1.39; 95% CI: 0.53,3.65; I 2 -0%, low certainty), and any stage NEC (5 studies; 767 participants; RR 0.98; 95% CI: 0.53,1.82; I 2 0%, very-low certainty) between three and twohourly feeding groups. There was no difference in the time to achieve full feeds (5 trials; 755 participants; MD: -0.0 days; 95% CI: -0.32, 0.31, low certainty) or other outcomes. On subgroup analysis, neonates with birthweight <1000 grams and in the three-hourly feeding regime achieved full enteral feeds slower than those in the two-hourly feeding group (1 trial; 84 participants; MD: 2.9 days, 95% CI: 1.16, 4.64, low certainty). ConclusionIn stable preterm infants (1000-1500 grams), three-hourly feeding can be followed safely. In infants <1000 grams, two-hourly feeding should be continued till further evidence. Prospero Registration Number: CRD42021246568What Is Known Most of the units follow two hourly feeding schedules without any evidence.Recent trials suggest that the three hourly feeding schedules can be safely followed in stable preterm infants. What Is NewLow certainty evidence suggest that three-hourly feeding is safe in stable preterm infants (1000-1500 grams).In infants < 1000 grams, two-hourly feeding should be continued as it helps in achieving full feeds earlier.

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Three-hourly feeding intervals are associated with faster advancement in very preterm infants

Cited by 7 publications

References 26 publications

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

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

Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue

Three-hourly versus two-hourly feeding interval in stable preterm infants: an updated systematic review and meta-analysis of randomized controlled trials

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