What do systematic reviews say?

Slow vs faster rates of enteral feed advancement

Slow showed no clear difference in necrotising enterocolitis before hospital discharge compared with faster rates of enteral feed advancement (moderate certainty).

• Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants 2021 · Cochrane Headline outcomes only
  RR 1.06 [0.83, 1.37]
  14 studies · 4026 participants
  Moderate

Late (seven days or more following birth) higher vs lower sodium intake

It is very uncertain whether late (seven days or more following birth) higher changes necrotising enterocolitis compared with lower sodium intake (very low certainty).

• Higher versus lower sodium intake for preterm infants 2023 · Cochrane Headline outcomes only
  RR 0.07 [0, 1.25]
  1 study · 49 participants
  Very low

Early (less than seven days following birth) higher vs lower sodium intake

It is very uncertain whether early (less than seven days following birth) higher changes necrotising enterocolitis compared with lower sodium intake (very low certainty).

• Higher versus lower sodium intake for preterm infants 2023 · Cochrane Headline outcomes only
  RR 4.6 [0.23, 90.84]
  1 study · 46 participants
  Very low

Lower vs higher oxygen concentrations titrated to target oxygen saturations during resuscitation of preterm infants at birth

Lower showed no clear difference in necrotising enterocolitis compared with higher oxygen concentrations titrated to target oxygen saturations… (low certainty).

• Lower versus higher oxygen concentrations titrated to target oxygen saturations during resuscitation of preterm… 2018 · Cochrane Headline outcomes only
  RR 0.98 [0.51, 1.87]
  8 studies · 807 participants
  Low

Early and late (day 1 to 28 after birth) higher vs lower sodium intake

• Higher versus lower sodium intake for preterm infants 2023 · Cochrane Headline outcomes only
  no estimate extracted
  0 studies · 0 participants
  GRADE not reported

High vs standard volume of unfortified human milk or term formula

It is very uncertain whether high changes necrotising enterocolitis compared with standard volume of unfortified human milk or term formula (very low certainty).

• High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants 2021 · Cochrane Headline outcomes only
  RR 1.03 [0.07, 15.78]
  1 study · 61 participants
  Very low

High vs standard volume of fortified human milk or preterm formula

It is very uncertain whether high changes necrotising enterocolitis compared with standard volume of fortified human milk or preterm formula (very low certainty).

• High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants 2021 · Cochrane Headline outcomes only
  RR 0.74 [0.12, 4.51]
  2 studies · 283 participants
  Very low

Early full enteral feeding vs delayed or progressive feeding

It is very uncertain whether early full enteral feeding changes necrotising enterocolitis compared with delayed or progressive feeding (very low certainty).

• Early full enteral feeding for preterm or low birth weight infants 2020 · Cochrane Headline outcomes only
  RR 0.98 [0.38, 2.54]
  6 studies · 522 participants
  Very low

Formula vs donor breast milk

Formula probably leads to higher necrotising enterocolitis compared with donor breast milk (moderate certainty).

• Formula versus donor breast milk for feeding preterm or low birth weight infants 2019 · Cochrane Headline outcomes only
  RR 1.87 [1.23, 2.85]
  9 studies · 1675 participants
  Moderate

Half strength formula vs full strength formula

The review found no eligible studies for this question.

• Dilute versus full‐strength formula in exclusively formula‐fed preterm or low birth weight infants 2019 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Intervention not reported

The intervention probably leads to lower necrotising enterocolitis (stage not reported) (moderate certainty).

• Early erythropoiesis‐stimulating agents in preterm or low birth weight infants 2020 · Cochrane Headline outcomes only
  RR 0.69 [0.52, 0.91]
  15 studies · 2639 participants
  Moderate

Probiotics vs control

• Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants 2023 · Cochrane Headline outcomes only
  no estimate extracted
  57 studies · 10918 participants
  Low

Probiotics vs control

• Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants 2023 · Cochrane Headline outcomes only
  no estimate extracted
  10 studies · 1836 participants
  Low

Prebiotic vs control

• Prebiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants 2023 · Cochrane Headline outcomes only
  no estimate extracted
  7 studies · 686 participants
  Low

Intervention not reported

The intervention may leads to lower necrotising enterocolitis prior to hospital discharge (low certainty).

• Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants 2022 · Cochrane Headline outcomes only
  RR 0.81
  13 studies · 1507 participants
  Low

Synbiotic vs control

• Synbiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants 2022 · Cochrane Headline outcomes only
  no estimate extracted
  6 studies · 907 participants
  Low

Intervention not reported

The intervention showed no clear difference in necrotising Enterocolitis ≥ Bell's stage 2 during initial hospital… (moderate certainty).

• Late erythropoiesis‐stimulating agents to prevent red blood cell transfusion in preterm or low birth weight infants 2020 · Cochrane Headline outcomes only
  RR 0.88 [0.45, 1.7]
  6 studies · 656 participants
  Moderate

Intervention not reported

The intervention showed no clear difference in necrotising enterocolitis (low certainty).

• Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants 2020 · Cochrane Headline outcomes only
  RR 1 [0.4, 2.5]
  2 studies · 130 participants
  Low

Intervention not reported

The intervention showed no clear difference in necrotising enterocolitis (moderate certainty).

• Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants 2020 · Cochrane Headline outcomes only
  RR 1.84 [0.87, 3.9]
  2 studies · 264 participants
  Moderate

Intervention not reported

The intervention leads to higher necrotising enterocolitis (high certainty).

• Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants 2017 · Cochrane Headline outcomes only
  RR 1.24 [1.05, 1.47]
  5 studies · 4929 participants
  High