Summary of findings 1. High compared to standard volume of fortified human milk or preterm formula in preterm or low birth weight infants.
| High compared to standard volume of fortified human milk or preterm formula in preterm or low birth weight infants | ||||||
| Patient or population: preterm or low birth weight infants Setting: neonatal intensive care unit (Australia and United States) Intervention: high volume feeds with fortified human milk or preterm formula Comparison: standard volume feeds with fortified human milk or preterm formula | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with standard volumes of fortified human milk or preterm formula | Risk with High volumes of fortified human milk or preterm formula | |||||
| Weight gain during hospital stay (g/kg/day) Follow‐up: Until discharge or 35‐36 weeks PMA |
The mean weight gain during hospital stay varied from 16.5 to 17.9 g/kg/day | MD 2.58 higher (1.41 higher to 3.76 higher) | ‐ | 271 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | Probably improves weight gain during hospital stay |
| Linear growth during hospital stay (cm/week) Follow‐up: Until discharge or 35‐36 weeks PMA |
The mean linear growth during hospital stay varied from 0.64 to 0.89 cm/week | MD 0.05 higher (0.02 lower to 0.13 higher) | ‐ | 271 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | May or may not improve linear growth during hospital stay |
| Head growth during hospital stay (cm/week) Follow‐up: Until discharge or 35‐36 weeks PMA |
The mean head growth during hospital stay varied from 0.59 to 0.83 cm/week | MD 0.02 higher (0.04 lower to 0.09 higher) | ‐ | 271 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | May or may not improve linear growth during hospital stay |
| Extrauterine growth restriction at discharge Follow‐up: Until discharge |
Study population | RR 0.71 (0.50 to 1.02) | 271 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | May or may not reduce extrauterine growth restriction at discharge | |
| 312 per 1,000 | 222 per 1,000 (156 to 318) | |||||
| Necrotising enterocolitis Follow‐up: Until discharge |
Study population | RR 0.74 (0.12 to 4.51) | 283 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 2 3 | Uncertainty regarding the effect on the risk of NEC | |
| 14 per 1,000 | 10 per 1,000 (2 to 62) | |||||
| *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; MD: Mean difference; PMA: Postmenstrual age; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded one level for serious imprecision due to small sample size
2 Downgraded one level for serious risk of bias due to lack of masking
3Downgraded by two levels for very serious imprecision due to small sample size and wide confidence interval