Summary of findings 1. Early full enteral feeding compared to delayed or progressive feeding for preterm or low birth weight infants.
| Early full compared to delayed/progressive enteral feeding for preterm or low birth weight infants | |||||
| Patient or population: preterm or low birth weight infants Setting: neonatal care facilities (India) Intervention: early full enteral feeding Comparison: delayed/progressive enteral feeding | |||||
| Outcomes | № of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | |
| Risk with delayed/progressive enteral feeding | Risk difference with early full enteral feeding | ||||
| In hospital rate of weight gain (g/kg/day) until term equivalent | 236 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | — | Meta‐analysis not possible due to different outcome measures. | |
| In hospital rate of head circumference growth (cm/week) until term equivalent – not reported | — | — | — | — | — |
| Growth restriction (z‐score of weight) at hospital discharge | 46 (1 RCT) | ⊕⊕⊝⊝ Lowa,d | — | The mean growth restriction (z‐score of weight) at hospital discharge was –1.09 | Mean 0.24 higher (0.06 higher to 0.42 higher) |
| Necrotising enterocolitis | 522 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,e,f | RR 0.98 (0.38 to 2.54) | Study population | |
| 31 per 1000 | 1 fewer per 1000 (19 fewer to 47 more) | ||||
| *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; RCT: randomised controlled trial; 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. | |||||
aDowngraded one level due to risk of surveillance and detection bias owing to lack of masking. bDowngraded one level due to wide range point estimates across the two trials (imprecision). cDowngraded one level due to opposite direction of effect (inconsistency). dDowngraded one level as analysis included data from one small trial (imprecision). eDowngraded one level due to moderate heterogeneity (inconsistency). fDowngraded one level due to wide 95% confidence interval (imprecision).