Topical Area: Maternal, Perinatal and Pediatric Nutrition
Nutrition guidelines for preterm infants based on systematic reviews are lacking. To address this need, the National Institute of Health and the Academy of Nutrition and Dietetics (AND) initiated a two phase project. Phase I: Convene stakeholders to identify topic areas and questions for preterm infant nutrition care. Phase II: Conduct scoping and systematic reviews, and develop evidence- based guidelines. This abstract presents summarized results of conducted macronutrient systematic reviews for the Very Low Birth Weight (VLBW) Preterm Infant Guideline.
Methods : The workgroup conducted scoping and systematic reviews. Identified macronutrient intake articles were categorized into the following subtopics: protein amount, protein type, fat amount, fat type, energy, breastmilk fortification, formula enrichment, and pasteurization. Inclusion criteria was limited to preterm infants < 1500 gm in developed nations. The workgroup participated in development of research questions, quality assessment of included articles using the Academy’s Quality Criteria Checklist and Cochrane’s Risk of Bias tools, synthesis and summarization of evidence, and development and grading of conclusion statements.
A total of 65 research questions were developed. Forty one studies published in 48 articles were included in the macronutrient subtopic; 47% were greater than 10 years old, and 32% greater than 20 years old. Thirteen studies had a low risk of bias (32%), 28 with selection bias (60%), 15 performance bias (32%), 13 attrition bias (28%), 3 reporting bias (6%), and 10 detection bias (21%). Approximately half of the studies (48%) demonstrated risk of bias in two or more Cochrane domains. The majority of conclusions statements (83%) were graded as limited due to quality, sample size, and wide confidence intervals; 7 conclusion statements graded as fair; and 4 graded as good.
Conclusions : The macronutrient systematic reviews highlight the wide variety of studied nutrition interventions for VLBW preterm infants. Heterogeneity between study interventions and reported outcomes increased difficulty in summarizing data and making strong, evidence-based recommendations.
Funding Sources : Academy of Nutrition and Dietetics