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

Abstract

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.

Effects of olfactory and/or gustatory stimuli on feeding of preterm infants: A systematic review and meta-analysis

“…Also, the heterogeneity may be related to the different frequencies of olfactory and gustatory stimuli during the intervention and the duration of the intervention. Some studies have shown that three-hour feeds are safe, as longer feeding intervals may improve blood flow and bowel motility after meals and help achieve complete enteral feeding earlier [ 29 ]. However, the studies included in this paper did not have a uniform duration and frequency of interventions, which leads to heterogeneity and thus affects the reliability of the results.…”

Guidelines for enteral nutrition in infants born preterm: 2023 update by the Portuguese Neonatal Society. Part I. Nutrient requirements and enteral feeding approach during the hospital stay

“…In VLBW infants, systematic reviews and meta-analyses concluded that while using intermittent feeding, 3-hourly versus 2-hourly feeding intervals are comparable, although extremely low-birth-weight (ELBW) infants (birth weight < 1000 g) may reach full enteral feeds earlier when fed twice-hourly 44,45 .…”

“…In brief, in VLBW infants, continuous and intermittent bolus feeding seem comparable, as are comparable 3-hourly or 2-hourly feeding intervals in intermittent feeding (LOE 3) 4,20 . In infants < 1000 g, a 2-hourly interval may be preferable (LOE 3) 44,45 .…”

Editorial: Topic opportunities, barriers and pitfall of current nutritional practice in preterm infants

“…Nevertheless, further research is required to determine whether extensively hydrolyzed milk powder can shorten the time of parenteral nutrition and reduce long-term complications. Significant differences exist in the method of nasogastric enteral feeding of preterm infants, especially in the continuous or bolus form and the frequency of feeding ( 5 ). The potential advantages and limitations of each form exist, and further research is required to confirm their advantages and disadvantages.…”