for the main comparison.
| Human milk‐derived multi‐nutrient fortifier compared with bovine milk‐derived multi‐nutrient fortifier for short‐term outcomes in preterm neonates | ||||||
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Patient or population: Preterm neonates (< 37 0/7 weeks' gestation) fed exclusively with breast milk Settings: Neonatal Intensive Care Unit/healthcare setting Intervention: Human milk‐derived multi‐nutrient fortifier Comparison: Bovine milk‐derived multi‐nutrient fortifier | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with bovine milk‐derived multi‐nutrient fortifier | Risk with human milk‐derived multi‐nutrient fortifier | |||||
| Necrotizing enterocolitis | Study population | RR 0.95, (0.20 to 4.54) | 125 (1) | ⊕⊕⊝⊝ lowa,b | ||
| 49.2 per 1000 | 46.9 per 1000 | RD ‐0.00, 95% CI ‐0.08 to 0.07 | ||||
| Death | Study population | (RR 0.71, 95% CI 0.17 to 3.06) | 121 (1) |
⊕⊕⊝⊝ lowa,b | ||
| 65.6 per 1000 | 46.9 per 1000 | (RD ‐0.02, 95% CI ‐0.10 to 0.06) | ||||
| Weight (change during intervention) (mean ± SD) |
1303 ± 610g | 1124 ± 534g | (MD ‐179.00, 95% CI ‐386.38 to 28.38) | 118 (1) | ⊕⊕⊝⊝ lowa,b | |
| Length (change during intervention) (mean ± SD) |
8.1 ± 4 cm | 7.3 ± 4 cm | (MD ‐0.80, 95% CI ‐2.25 to 0.65) | 118 (1) | ⊕⊕⊝⊝ lowa,b | |
| Head circumference (change during intervention) (mean ± SD) |
6.8 ± 2.5 cm | 6.2 ± 2.6 | (MD ‐0.60, 95% CI ‐1.52 to 0.32) | 118 (1) | ⊕⊕⊝⊝ lowa,b | |
| Feeding interruption requiring parenteral nutrition | Study population | (RR 2.86, 95% CI 0.31 to 26.75) | 125 (1) |
⊕⊕⊝⊝ lowa,b | ||
| 16.4 per 1000 | 46.9 per 1000 | (RD ‐0.02, 95% CI ‐0.10 to 0.06) | ||||
| Late‐onset sepsis | Study population | (RR 0.54, 95% CI 0.25 to 1.21) | 125 (1) |
⊕⊕⊝⊝ lowa,b | ||
| 229.5 per 1000 | 125 per 1000 | (RD ‐0.10, 95% CI ‐0.24 to 0.03) | ||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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; RR: Risk Ratio; RD: Risk Difference; MD: Mean Difference. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aImprecision as suggested by wide 95% confidence intervals
bInclusion of a single eligible study