Early exclusive enteral feeding versus gradual advancement in preterm infants: a systematic review and meta-analysis of randomized clinical trial

Abstract

Introduction: Preterm infants are at high risk of complications to gastrointestinal immaturity, including necrotising enterocolitis (NEC) and feeding intolerance. The optimal enteral feeding strategy remains uncertain. Methodology: A meta-analysis compared early exclusive enteral feeding with gradual enteral feeding advancement. PubMed, Embase, and Cochrane were searched. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals were calculated. Results: Seven studies including 2,649 preterm infants were analysed. No significant differences were observed for NEC (RR0.88; p=0.77) or feeding intolerance (RR0.82; p=0.48). Early exclusive enteral feeding appeared associated with shorter hospital stay (MD −4.81 days; p=0.03) and reduced intravenous fluid use (MD −3.19 days; p=0.02). Conclusion: Early exclusive enteral feeding appears safe and may reduce hospitalisation and intravenous fluid exposure in preterm infants.