Continuous versus intermittent bolus milk feeding in preterm infants: a meta-analysis

Objectives To analyze the evidence comparing the benefits and risks of continuous versus intermittent milk feeding in low birth weight (LBW) infants. Methods Three electronic databases were searched and screened to identify randomized controlled trials of continuous and intermittent milk feeding of LBW infants up to October 2016. Results Eight trials were included in this meta-analysis. Continuous feeding had no effect on days to full feeds and time to regain birth weight. There were no significant differences in the number of apneas, invasive ventilation, changes in body length, occipitofrontal circumference, skinfold thickness, and total protein, and in the number of stools between the two feeding strategies. Continuous feeding was associated with higher gastric residual volume, noninvasive ventilation, weight gain, increase in bilirubin, and longer nil by mouth. There were no significant differences in adverse events and confounders between the two feeding strategies. Conclusions Continuous milk feeding was superior to intermittent feeding in LBW infants in terms of weight gain. However, continuous feeding was also associated with increased nil by mouth duration, increased bilirubin, increased noninvasive support, and increased gastric residuals. Continuous feeding thus confers advantages in terms of weight gain, but also has disadvantages compared with bolus feeding.