Outcomes of Early Enteral Feeding in Very Low Birth Weight Infants: A Meta-Analysis of Randomized Controlled Trials

Abstract

In this study, we aimed to evaluate the outcomes of early enteral feeding among very low birth weight (VLBW) infants.We searched PubMed, the Cochrane Library, Scopus, and Web of Science up to October 2025.The intervention group was identified from randomized controlled trials (RCTs) wherein feeding was started early (72 h), and those with delayed initiation served as controls.Metaanalysis was performed using RevMan 5.4 software.Seventeen RCTs were included in the metaanalysis.Early feeding did not significantly increase the risk of mortality (risk ratio [RR] = 0.72; 95% confidence interval [CI]: 0.51 to 1.01) or necrotizing enterocolitis (NEC; RR = 1.02; 95% CI: 0.76 to 1.37).It was associated with a significant reduction in the incidence of sepsis (RR = 0.78; 95% CI: 0.61 to 0.98), shortening in the time to full enteral feeding (mean difference [MD] = -2.72 days; 95% CI: -5.08 to -0.36), and a borderline reduction in the duration of hospitalization (MD = -4.54days; 95% CI: -8.86 to -0.04).No significant differences were found in the incidence of intraventricular hemorrhage (IVH), gastrointestinal bleeding, bronchopulmonary dysplasia, and feeding intolerance as well as weight gain.Subgroup analyses indicated shorter durations of hospitalization with feeding after 48 h and lower IVH rates in studies published after 2000, while other outcomes showed no significant differences.Early enteral feeding in VLBW infants did not increase major adverse outcomes and may provide modest benefits, such as shorter time to full enteral feeding, without significantly affecting NEC, or IVH rates.On the basis of the available RCT data, early feeding did not show evidence of increased harm.However, given the substantial heterogeneity and variability across studies, these findings should be interpreted with caution.More high-quality trials are needed to optimize timing and feeding protocols.