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.
Keywords neonatology - feeding - pediatrics - outcomes - preterm - very low birth weight
