Early versus delayed introduction of human milk fortification in enterally fed preterm infants: A systematic review and meta-analysis

Cathie Hilditch, Amy Keir, Carmel T. Collins, Philippa Middleton, Judith Gomersall

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)

Abstract

Aim: To assess effects of early versus delayed introduction of human milk fortification in preterm infants. 

Methods: We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PubMed and CINAHL for randomised controlled trials evaluating start time for human milk fortification in preterm infants (March 2020). Two authors assessed trial eligibility and risk of bias, extracted data and assessed evidence certainty. 

Results: We identified 1307 publications and included three trials (378 infants). Meta-analysis comparing fortification commencing at an enteral feed volume of ≤40 mL/kg/day versus ≥75 mL/kg/day, showed little to no difference in rates of necrotising enterocolitis (3 trials), sepsis (3 trials), feeding intolerance (2 trials) (low-quality evidence) and infant growth (1 trial, very low-quality evidence). 

Conclusions: Whether early introduction of fortification, at an enteral feed volume of ≤40 mL versus delayed at ≥75 mL/kg/day improves growth or influences adverse feeding outcomes is very uncertain.

Original languageEnglish
Pages (from-to)30-38
Number of pages9
JournalJournal of Paediatrics and Child Health
Volume58
Issue number1
DOIs
Publication statusPublished - Jan 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Keywords

  • breastmilk
  • fortification
  • meta-analysis
  • preterm infant
  • systematic review

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