Intervention Review

Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

  1. Felicia M McCormick2,
  2. Karen Tosh3,
  3. William McGuire1,*

Editorial Group: Cochrane Neonatal Group

Published Online: 17 FEB 2010

Assessed as up-to-date: 22 DEC 2009

DOI: 10.1002/14651858.CD005255.pub3

Database Title

Additional Information

How to Cite

McCormick FM, Tosh K, McGuire W. Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD005255. DOI: 10.1002/14651858.CD005255.pub3.

Author Information

  1. 1

    Hull York Medical School, Centre for Reviews and Dissemination, York, Y010 5DD, UK

  2. 2

    University of York, Mother and Infant Research Unit, Department of Health Sciences, York, UK

  3. 3

    University Of St Andrews, Centre For Public Policy and Management, Fife, Scotland, UK

*William McGuire, Centre for Reviews and Dissemination, Hull York Medical School, University of York, York, Y010 5DD, UK. William.McGuire@hyms.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 17 FEB 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Scheduled interval feeding of prescribed enteral volumes is current standard practice for preterm infants. However, feeding preterm infants in response to their hunger and satiation cues (ad libitum or demand/semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.

Objectives

To assess the effect of a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding prescribed volumes at scheduled intervals on growth rates and the time to hospital discharge.

Search methods

We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2009), MEDLINE (1966 to Oct 2009), EMBASE (1980 to Oct 2009), CINAHL (1982 to Oct 2009), conference proceedings, and previous reviews.

Selection criteria

Randomised or quasi-randomised controlled trials (including cluster randomised trials) that compared a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding at scheduled intervals.

Data collection and analysis

We used the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors.

Main results

We found eight randomised controlled trials that compared ad libitum or demand/semi-demand regimens with scheduled interval regimes in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and of variable methodological quality. The duration of the intervention and the duration of data collection and follow-up in most of the trials was not likely to have allowed detection of measurable effects on growth. Three trials reported that feeding preterm infants using an ad libitum or demand/semi-demand feeding regimen allowed earlier discharge from hospital (by about two to four days) but other trials did not confirm this finding.

Authors' conclusions

Limited evidence exists that feeding preterm infants with ad libitum or demand/semi-demand regimens allows earlier attainment of full oral feeding and earlier hospital discharge. This finding should be interpreted cautiously because of methodological weaknesses in the included trials. A large randomised controlled trial is needed to confirm this finding and to determine if ad libitum of demand/semi-demand feeding of preterm infants affects other clinically important outcomes.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

We identified eight small trials that examined whether feeding preterm infants in response to their own hunger cues is better than feeding set volumes of milk at predefined intervals. In general these were methodologically flawed and did not report on all important clinical outcomes. Some evidence was found to suggest that feeding preterm infants in response to their own hunger cues results in earlier hospital discharge by about 2 to 4 days. Further randomised controlled trials are needed to confirm this finding.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於早產兒的隨意或需求/半需求餵食(Ad libitum or demand/semidemand feeding)與計劃性的間隔餵食(scheduled interval feeding)

計劃性的間隔餵食是現行標準餵食早產兒的做法。然而，依早產兒的飢餓或飽食餵食(隨意或需求/半需求)，而不是在預定的時間餵食，可能有助於建立獨立的口腔餵食(oral feeding)，增加營養攝入量和增長率，並可以早期出院。

目標

評估以隨意或需求/半需求為基礎餵養和預定時間預定份量的餵養早產兒，在生長速率和出院時間的差別

搜尋策略

我們使用Cochrane Neonatal Review Group的標準搜尋策略:包含搜尋Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2009), MEDLINE (1966 to Oct 2009), EMBASE (1980 to Oct 2009), CINAHL (1982 to Oct 2009),會議記錄和之前的文獻

選擇標準

隨機或半隨機對照試驗(包含群聚隨機試驗)比較以隨意或需求/半需求為基礎餵養和預定時間預定份量的餵養早產兒的差別

資料收集與分析

我們使用Cochrane Neonatal Review Group的標準方式並由兩個作者獨立評估試驗的品質和擷取的數據

主要結論

我們發現 8個隨機對照試驗，比較早產兒在由胃管到口腔餵食的過度期中，隨意或需求/半需求餵食和間隔餵食的效果。這些試驗普遍樣本數少且方法學的品質參差不齊。試驗介入的時間、期間收集的數據和後續追蹤，不足以偵測到生長的影響。3個試驗報告指出，使用隨意或需求/半需求餵養早產兒有較早的出院趨勢(大約 2至4天)，但其他5個試驗並沒有證實這一發現。

作者結論

有限的證據顯示，以隨意或需求/半需求餵食早產兒，有較早的口腔餵養和較早出院。這一發現應謹慎解讀，因為該些研究方法有其弱點。目前尚需一項大型隨機對照試驗來證實這一發現，並確定是否以隨意或需求/半需求來餵養早產兒有其他臨床重要影響。

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於早產兒的隨意或需求/半需求餵食與計劃性的間隔餵食： 我們找出八個小型的試驗，檢視依照早產兒本身飢餓來餵食是否比間隔時間以固定餵食量餵食有較好的效果。這些研究方法上皆存在缺陷，且沒有報告所有重要的臨床結果。一些證據指出，依照早產兒飢餓反應餵食可以較早出院(約二到四天)。而目前尚需更進一步的隨機對照試驗來證實這個發現。

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