Abstract
Probiotics have been linked to a reduction in the incidence of necrotizing enterocolitis and late-onset sepsis in preterm infants. Recently, probiotics have also proved to reduce time to achieve full enteral feeding (FEF). However, the relationship between FEF achievement and type of feeding in infants treated with probiotics has not been explored yet. The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics in reducing time to achieve FEF in preterm infants, according to type of feeding (exclusive human milk (HM) vs. formula). Randomized-controlled trials involving preterm infants receiving probiotics, and reporting on time to reach FEF were included in the systematic review. Trials reporting on outcome according to type of feeding (exclusive HM vs. formula) were included in the meta-analysis. Fixed-effect or random-effects models were used as appropriate. Results were expressed as mean difference (MD) with 95% confidence interval (CI). Twenty-five studies were included in the systematic review. In the five studies recruiting exclusively HM-fed preterm infants, those treated with probiotics reached FEF approximately 3 days before controls (MD −3.15 days (95% CI −5.25/−1.05), p = 0.003). None of the two studies reporting on exclusively formula-fed infants showed any difference between infants receiving probiotics and controls in terms of FEF achievement. The limited number of included studies did not allow testing for other subgroup differences between HM and formula-fed infants. However, if confirmed in further studies, the 3-days reduction in time to achieve FEF in exclusively HM-fed preterm infants might have significant implications for their clinical management.
Highlights
Nutrition during critical time windows in early life can affect long-term health [1]
PRISMA guidelines [15] were followed in order to perform a systematic review of published studies reporting the relationship between probiotic use and time to full enteral feeding (FEF) achievement in preterm infants according to type of feeding
Only eight studies reported FEF achievement according to type of feeding: infants were fed exclusively HM, either own mother’s (OMM) or donor human milk (DHM), in six studies [22,38,50,56,60,70], while two studies reported FEF in exclusively formula-fed infants [41,61]
Summary
Nutrition during critical time windows in early life can affect long-term health [1]. Provision of optimal enteral nutrition to preterm infants might improve neurodevelopmental outcome by decreasing the rate of several complications of prematurity, such as extrauterine growth restriction, necrotizing enterocolitis (NEC), sepsis, bronchopulmonary dysplasia, and retinopathy of prematurity [2]. The consequent prolonged need for parenteral nutrition can have serious infectious and metabolic complications, which might prolong hospital stay, increase morbidity and mortality, and affect growth and development [4]. Several clinical variables and interventions have been proposed as predictors of the time to FEF achievement in preterm and very-low-birth-weight (VLBW) infants. Among these variables, the influence of type of feeding was documented, as FEF achievement was delayed in formula-fed infants compared to human milk (HM)-fed infants [5]
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