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

Abstract

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.

Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts

“…Bolus feeds promote cyclical release of gastrointestinal tract hormones to stimulate gut maturation and motility (208) but marked variations in practice exist and many use continuous feeds (183). Low‐quality evidence suggests feeding 3‐hourly is comparable to 2‐hourly feeding although extremely low‐birth‐weight infants may reach full enteral feeds earlier when fed 2‐hourly compared with 3‐hourly (209). Bolus feeding increases splanchnic perfusion more than continuous feeding (210).…”

The time to initiate trophic feeding and its predictors among preterm neonate admitted to neonatal intensive care unit, Multicenter study, Northwest Ethiopia

“…The content of the questionnaire includes neonatal and maternal socio-demographic variables (gestational age, birth weight, age of the mother, residence and educational status), neonatal (first and fifth minutes APGAR score, meconium passage, sucking reflex, continuous positive air pressure, perinatal asphyxia, hemodynamic instabilities, birth defect, obstructions, respiratory distress syndrome, meconium aspiration syndrome, blood transfusion, phototherapy) and maternal related factors (sero-status of the mother, hypertensive disorder during pregnancy, mode of delivery, birth type, place of delivery, parity, postpartum hemorrhage and diabetes mellitus) and health service-related factors (frequency of order revision). The data extraction checklist and questionnaire were adapted from different related literature, books, and guidelines [17,26,[31][32][33][34][35][36][37][38][39].…”

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 .…”