Summary of findings 1. Early versus late fortification of human milk in preterm infants.
| Early versus late fortification of human milk in preterm infants | ||||||
| Patient or population: preterm infants Settings: neonatal unit Intervention: early fortification Comparison: late fortification | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Late fortification | Early fortification | |||||
| Time to regain birth weight (days) | Mean time to regain birth weight (days) in the intervention groups was 0.06 lower (1.32 lower to 1.2 higher) | 237 (2 studies) | ⊕⊕⊝⊝ lowa,b | |||
| Linear growth (cm/week) | Mean linear growth (cm/week) in the intervention groups was 0.1 higher (0.03 lower to 0.22 higher) | 237 (2 studies) | ⊕⊕⊝⊝ lowa,b | |||
| Increase in head circumference (cm/week) | Mean increase in head circumference (cm/week) in the intervention groups was 0.01 lower (0.07 lower to 0.06 higher) | 237 (2 studies) | ⊕⊕⊝⊝ lowa,b | |||
| Necrotising enterocolitis stage 2 or 3 | Study population | RR 1.36 (0.44 to 4.16) | 237 (2 studies) | ⊕⊕⊝⊝ lowa,b | ||
| 43 per 1000 | 58 per 1000 (19 to 178) | |||||
| Moderate | ||||||
| 42 per 1000 | 57 per 1000 (18 to 175) | |||||
| Time to reach full enteral feeds | Mean time to reach full enteral feeds in the intervention groups was 0.27 higher (3.48 lower to 4.02 higher) | 237 (2 studies) | ⊕⊕⊝⊝ lowa,b | |||
| Extrauterine growth restriction at discharge | Study population | RR 1.06 (0.81 to 1.39) | 237 (2 studies) | ⊕⊕⊝⊝ lowa,b | ||
| 342 per 1000 | 362 per 1000 (277 to 475) | |||||
| Moderate | ||||||
| 385 per 1000 | 408 per 1000 (312 to 535) | |||||
| Proportion of infants with feed interruption episodes | Study population | RR 0.99 (0.73 to 1.34) | 237 (2 studies) | ⊕⊕⊝⊝ lowa,b | ||
| 402 per 1000 | 398 per 1000 (293 to 538) | |||||
| Moderate | ||||||
| 389 per 1000 | 385 per 1000 (284 to 521) | |||||
| *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. | ||||||
| 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. | ||||||
aLack of blinding. bSmall sample size.