Early versus delayed introduction of human milk fortification in enterally fed preterm infants: A systematic review and meta-analysis.

Abstract

AIM\nTo assess effects of early versus delayed introduction of human milk fortification in preterm infants.\n\n\nMETHODS\nWe searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PubMed and CINAHL for randomised controlled trials evaluating start time for human milk fortification in preterm infants (March 2020). Two authors assessed trial eligibility and risk of bias, extracted data and assessed evidence certainty.\n\n\nRESULTS\nWe identified 1307 publications and included three trials (378 infants). Meta-analysis comparing fortification commencing at an enteral feed volume of ≤40\u2009mL/kg/day versus ≥75\u2009mL/kg/day, showed little to no difference in rates of necrotising enterocolitis (3 trials), sepsis (3 trials), feeding intolerance (2 trials) (low-quality evidence) and infant growth (1 trial, very low-quality evidence).\n\n\nCONCLUSIONS\nWhether early introduction of fortification, at an enteral feed volume of ≤40\u2009mL versus delayed at ≥75\u2009mL/kg/day improves growth or influences adverse feeding outcomes is very uncertain.