Abstract
BACKGROUND: Preterm neonates often face challenges related to enteral nutrition initiation, and the optimal timing remains a subject of ongoing debate. STUDY AIM: This meta-analysis aimed to synthesize evidence from randomized controlled trials (RCTs) comparing early versus delayed enteral nutrition initiation in preterm neonates. METHODS: A systematic literature search identified eight RCTs meeting inclusion criteria, encompassing diverse populations and protocols. The primary outcome assessed was the incidence of feeding intolerance. Meta-analysis was conducted using a fixed-effects model, and heterogeneity was assessed. RESULTS: The meta-analysis demonstrated that early enteral feeding significantly increased the incidence of feeding intolerance among preterm infants (OR: 1.54, 95% CI: 1.18-2.01). Individual studies exhibited varying trends, with some indicating balanced risks and others suggesting increased feeding intolerance in the early initiation group. The findings underscore the importance of considering individual patient characteristics and local protocols when determining the timing of enteral nutrition initiation. Variability in outcomes across different populations highlights the need for tailored approaches in neonatal care. CONCLUSION: This meta-analysis contributes insights into the association between early enteral feeding initiation and feeding intolerance in preterm neonates. Clinicians should adopt a nuanced approach, emphasizing vigilant monitoring and timely adjustments in enteral nutrition practices. Further research, including large-scale RCTs with standardized protocols, is warranted to refine guidelines and optimize neonatal care practices.