Summary of findings for the main comparison. Summary of findings table 1. Oral stimulation intervention versus standard care.
| Comparison group 1 | ||||||
| Patient or population: preterm infants Setting: NICU Intervention: oral stimulation Comparison: standard care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with standard care | Risk with oral stimulation | |||||
| Days to full oral feeding | Mean days to full oral feeding: 0 | Mean days to full oral feeding in the intervention group: 5.22, undefined lower (6.86 lower to 3.59 lower) | ‐ | 376 (8 RCTs) | ⊕⊕⊝⊝ Low a,b,c,d,e,f,g,h | Heterogeneity (I2= 68%) between these studies was substantial, with high risk of bias overall between them. |
| Weight gain | Mean weight gain: 0 | Mean weight gain in the intervention group: 0.05, undefined lower (1.19 lower to 1.09 higher) | ‐ | 81 (2 RCTs) | ⊕⊕⊝⊝ Lowa,b,e,f,g | |
| Total hospital stay (days) | Mean total hospital stay (days): 0 | Mean total hospital stay (days) in the intervention group: 5.26, undefined lower (7.34 lower to 3.19 lower) | ‐ | 301 (7 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c,d,e,f | |
| Duration (days) of parenteral nutrition | Mean duration (days) of parenteral nutrition: 0 | Mean duration (days) of parenteral nutrition in the intervention group: 5.3, undefined lower (9.73 lower to 0.87 lower) | ‐ | 19 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c,f | |
| Exclusive direct breast feeding at discharge | 350 per 1000 | 641 per 1000 (366 to 847) | RR 1.83 (0.96 to 3.48) | 59 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c,e | |
| Any direct breast feeding at discharge | 348 per 1000 | 431 per 1000 (202 to 925) | RR 1.24 (0.58 to 2.66) | 110 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c,d | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
aHigh risk of selection bias.
bHigh risk of performance bias.
cHigh risk of detection bias.
dSubstantial heterogeneity (50% to 90%).
eHigh risk of attrition bias.
fHigh risk of reporting bias.
gModerate heterogeneity (30% to 60%).
hConsiderable heterogeneity (75% to 100%).