FNCE 2023
Session 357. Providing MNT for the Pediatric Type 1 Diabetes Population: What Does the Evidence Show?
Monday, October 9, 8:30 AM - 9:30 AM
See session information ♦ See EAL review results

Preterm Infant (VLBW) Enteral Nutrition

VLBW: Type of Fat (2020)

Intervention
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on mortality?
- Conclusion
  One large RCT found no significant effect [relative risk of 1.31 (95%CI, 0.88 to 1.96)] on mortality in very low birthweight (VLBW) preterm infants receiving 60mg of DHA and 4mg of EPA per day, compared to placebo after approximately three months.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on mortality?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on necrotizing enterocolitis?
- Conclusion
  There was no significant effect (RR (95% CI) of 1.17 (0.80 to 1.71) on incidence of necrotizing enterocoloties (NEC) in very low birth weight preterm infants that received daily long chain omega-3 supplementation, with or without arachidonic acid (AA), for approximately 1-3 months compared to placebo.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on necrotizing enterocolitis?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on bronchopulmonary disease?
- Conclusion
  Long chain omega-3 supplementation, provided as 60mg or less, in a marine oil fatty acid directly to the infant or through a lactating mother, for two to four months, did not significantly affect [RR of 0.85 (95% CI, 0.61 to 1.18)] incidence of bronchopulmonary disease. Heterogeneity of results was high (I²=79.61%), so these results should be interpreted with caution.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on bronchopulmonary disease?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on retinopathy of prematurity?
- Conclusion
  There was no significant effect of daily long-chain omega-3 supplementation, with or without arachidonic acid (AA), on retinopathy of prematurity (ROP) after one to three months of supplementation, compared to placebo, in very low birthweight (VLBW) preterm infants.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on retinopathy of prematurity?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on atopy (hay fever)?
- Conclusion
  Supplementing lactating mothers with 500mg of DHA-rich capsules for nine weeks did not significantly affect risk of hay fever at 18 months of age (RR, 0.85; 95% CI, 0.23 to 3.13) in very low birthweight (VLBW) preterm infants.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on atopy (hay fever)?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Manley B, Makrides M, Collins C, McPhee A, Gibson R, Ryan P, Sullivan T, Davis P. High-dose docosahexaenoic acid supplementation of preterm infants: respiratory and allergy outcomes. Pediatrics 2011; 128:e71-7
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on neurodevelopment?
- Conclusion
  Long-chain omega-3 supplementation for two to three months in very low birthweight (VLBW) preterm infants fed MOM did not have a significant effect (MD, 3.065; 95% CI, -0.988 to 7.118) on total Bayley II Mental Developmental Index or Ages and Stages Questionnaire score at 18 months to 20 months or full IQ score at seven years of age.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on neurodevelopment
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on visual acuity?
- Conclusion
  Long chain omega-3 supplementation at a daily level of 0.2-6.9% fatty acids as DHA, 0-0.3% EPA initially improved visual acuity compared to standard care in VLBW preterm infants. However, these benefits disappeared by 4 months corrected age. When 0.34% DHA was delivered with or without 0.60% AA for one month, there was no effect on visual acuity compared to standard care.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy via enteral nutrition on visual acuity?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on feeding tolerance?
- Conclusion
  In one large RCT, daily supplementation of 64mg of long chain omega-3 for three months had no significant effect (MD, 0.1; 95% CI, 1.98 lower to 1.78 higher), compared to placebo, on days until full enteral feeds in very low birthweight (VLBW) preterm infants.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy via enteral nutrition on feeding tolerance?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on weight gain?
- Conclusion
  Long-chain omega-3 supplementation (docosahexaenoic acid [DHA] or eicosapentaeonic acid [EPA]) in human milk did not significantly affect weight in very low birth weight (VLBW) infants, but the effect of supplementation in formula was mixed. While limited evidence suggested that formula with DHA may have no effect or may even decrease weight compared to controls, when arachidonic acid was added to DHA for 30 days, infant had significantly greater weight gain compared to controls at 57 weeks post-menstrual age.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on weight gain?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on length gain?
- Conclusion
  Long chain omega 3 supplementation, with or without the addition of arachidonic acid, did not significantly affect length gain at term and up to 18 months of age in very low birthweight preterm infants receiving human milk or infant formula.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on length gain?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on head circumference?
- Conclusion
  The effect of long chain omega-3 supplementation through human milk and formula on head circumference in very low birthweight preterm infants is unclear.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on head circumference?
- Search Plan and Results: VLBW: Type of Fat (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on sepsis?
- Conclusion
  There was no significant effect (RR (95% CI) of 0.94 (0.81, 1.10) on incidence of sepsis in very low birthweight preterm infants that received daily long-chain omega-3 supplementation, with or without arachidonic acid, for approximately 1-3 months, compared to placebo.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on sepsis?
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of fat via enteral nutrition on adverse effects?
- Conclusion
  Limited evidence suggests no difference in adverse events between long-chain omega-3, with or without arachidonic acid, and control supplements in very low birth weight (VLBW) preterm infants.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of at via enteral nutrition on adverse effects?