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Meta-Analysis
. 2016 Jul 30;8(8):471.
doi: 10.3390/nu8080471.

Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis

Arianna Aceti  1   2 , Davide Gori  3   4 , Giovanni Barone  5   6 , Maria Luisa Callegari  7   8 , Maria Pia Fantini  9   10 , Flavia Indrio  11   12   13 , Luca Maggio  14   15   16 , Fabio Meneghin  17   18 , Lorenzo Morelli  19   20 , Gianvincenzo Zuccotti  21   22 , Luigi Corvaglia  23   24   25
Affiliations
Meta-Analysis

Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis

Arianna Aceti et al. Nutrients. .

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.

Keywords: full enteral feeding; human milk; preterm infants; probiotics; systematic review.

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Figures

Figure 1
Figure 1
Flow chart of the search strategy used for the systematic review. The relevant number of papers at each point is given.
Figure 2
Figure 2
Forest plot (2a) and funnel plot (2b) showing the association between the use of probiotics and achievement of full enteral feeding in exclusively human milk-fed preterm infants. IV: inverse variance method.
See this image and copyright information in PMC

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