Table 4.
Evidence quality assessment of according to the GRADE guidelines
| First author | Health outcomes | Study limitation | Indirectness | Publication bias | Imprecision | Inconsistency | Confidence |
|---|---|---|---|---|---|---|---|
| Pammi et al. | Hospital stay ↓ | -1 | 0 | 0 | 0 | -1 | low |
| urinary tract infection ↓ | -1 | 0 | 0 | 0 | -1 | low | |
| Morbidity: LOS ↓ | -1 | 0 | 0 | 0 | -1 | low | |
| Morbidity: Fungal sepsis ↓ | -1 | 0 | 0 | 0 | 0 | moderate | |
| Howlett et al. | Mortality: Neonatal death ↓ | 0 | 0 | 0 | 0 | -1 | moderate |
| Chi et al. | Days achieve full enteral feeding↓ | 0 | 0 | -1 | 0 | -2 | Very low |
| Hospital stay ↓ | 0 | 0 | -1 | 0 | -2 | Very low | |
| Stool frequency ↑ | 0 | 0 | -1 | -1 | 0 | low | |
| Morbidity: Sepsis ↓ | 0 | 0 | 0 | 0 | 0 | high | |
| mortality↓ | 0 | 0 | 0 | 0 | 0 | high | |
| Armannia et al. | Phototherapy rate ↓ | -1 | 0 | 0 | -1 | 0 | low |
| Hospital stay ↓ | -1 | 0 | 0 | -1 | 0 | low | |
| Stool frequency ↑ | 0 | 0 | 0 | 0 | 0 | high | |
| Morbidity: Hyperbilirubina-emia ↓ | -1 | 0 | 0 | -1 | 0 | low | |
| Amissah et al. | Weight ↑ | -1 | 0 | 0 | 0 | -1 | low |
| Length ↑ | -1 | 0 | 0 | 0 | -1 | low | |
| HC↑ | -1 | 0 | 0 | 0 | -1 | low | |
| Blood urea nitrogen ↑ | -1 | 0 | 0 | 0 | -1 | low | |
| Hospital stay ↑ | -1 | 0 | 0 | -2 | 0 | Very low | |
| Amissah et al. | Weight ↑ | -1 | -1 | 0 | -1 | 0 | Very low |
| Hospital stay ↓ | -1 | -1 | 0 | -1 | 0 | Very low | |
| Yang et al. | Length ↑ | 0 | 0 | 0 | 0 | 0 | high |
| HC ↑ | 0 | 0 | 0 | 0 | 0 | high | |
| Ig-A ↑ | 0 | 0 | 0 | 0 | 0 | high | |
| Ig-G ↑ | 0 | 0 | -1 | -1 | 0 | low | |
| IL-12 ↑ | 0 | 0 | 0 | -1 | 0 | moderate | |
| Shah et al. | Morbidity: NEC ↓ | 0 | 0 | -1 | 0 | 0 | moderate |
| Aceti et al. | Morbidity: LOS ↓ | 0 | 0 | 0 | 0 | 0 | high |
| Moe-Byrne et al. | Days achieve full enteral feeding ↓ | 0 | 0 | -1 | 0 | 0 | moderate |
| Moon et al. | Weight ↑ | 0 | 0 | -1 | 0 | -1 | low |
| Length ↑ | 0 | 0 | -1 | 0 | -1 | low | |
| AlFaleh et al. | Hospital stay ↓ | -1 | 0 | 0 | 0 | -2 | Very low |
| Days achieve full enteral feeding ↓ | -1 | 0 | -1 | 0 | -2 | Very low | |
| NEC ↓ | -1 | 0 | -1 | 0 | 0 | low | |
| Mortality↓ | -2 | 0 | 0 | -1 | 0 | Very low | |
| Young et al. | Visual acuity↑ | 0 | 0 | -1 | -1 | 0 | low |
| Bone mineral content (4/12 months) ↑ | 0 | 0 | -1 | -1 | 0 | low | |
| Verner et al. | Intestinal fat absorption ↑ | 0 | 0 | 0 | -1 | -1 | low |
LOS Late-onset sepsis; HC Head circumference; NEC Necrotizing enterocolits
Study limitation: Downgraded two level to study risk of bias at two or more points. Downgraded one level to study risk of bias at one point
Indirectness: Downgraded one level due to a conclusion indirectly
Publication bias: Downgraded on level due to funnel plot is not symmetrical or fewer than nine studies were included
Imprecision: Downgraded one level due to uncertainty about precision.
Inconsistency: Downgraded one level due to included studies : 75%≤ I2 ≤100%; Downgraded two level due to included studies: 50≤ I2 < 75%