What do systematic reviews say?

NIPPV vs NCPAP

Nasal intermittent positive pressure ventilation (NIPPV) showed no clear difference in necrotising enterocolitis compared with nasal continuous positive airway pressure (NCPAP) (moderate certainty).

• Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for… 2023 · Cochrane Headline outcomes only
  RR 0.86 [0.65, 1.15]
  10 studies · 2069 participants
  Moderate

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

Continuous vs intermittent bolus (nasogastric and orogastric tube) milk feeding ‐ all preterm infants less than 1500 grams

Continuous showed no clear difference in necrotising enterocolitis (NEC) compared with intermittent bolus (nasogastric and orogastric tube) milk feeding ‐… (low certainty).

• Continuous nasogastric milk feeding versus intermittent bolus milk feeding for preterm infants less than 1500 grams 2021 · Cochrane Headline outcomes only
  RR 1.19 [0.67, 2.11]
  4 studies · 372 participants
  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

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

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 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

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

Short feeding interval vs long feeding interval

Short feeding interval showed no clear difference in necrotising enterocolitis compared with long feeding interval (low certainty).

• Short versus long feeding interval for bolus feedings in very preterm infants 2021 · Cochrane Headline outcomes only
  RR 1.07 [0.54, 2.11]
  4 studies · 417 participants
  Low

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

Enteral zinc supplementation vs no zinc supplementation

Enteral zinc supplementation showed no clear difference in necrotising enterocolitis compared with no zinc supplementation (low certainty).

• Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates 2021 · Cochrane Headline outcomes only
  RR 0.08 [0, 1.33]
  1 study · 193 participants
  Low

Carbohydrate supplementation vs control

It is very uncertain whether carbohydrate supplementation changes necrotising enterocolitis compared with control (very low certainty).

• Carbohydrate supplementation of human milk to promote growth in preterm infants 2020 · Cochrane Headline outcomes only
  RR 0.18 [0.02, 1.3]
  1 study · 75 participants
  Very low

Fat supplementation vs control

The review found no eligible studies for this question.

• Fat supplementation of human milk for promoting growth in preterm infants 2020 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Intervention not reported

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

• Multi‐nutrient fortification of human milk for preterm infants 2020 · Cochrane Headline outcomes only
  RR 1.37 [0.72, 2.63]
  13 studies · 1110 participants
  Low

Protein supplementation vs control

It is very uncertain whether protein supplementation changes necrotising enterocolitis compared with control (very low certainty).

• Protein supplementation of human milk for promoting growth in preterm infants 2020 · Cochrane Headline outcomes only
  RR 1.11 [0.07, 18.49]
  1 study · 76 participants
  Very low

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

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

Intervention not reported

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

• Nutrient‐enriched formula versus standard formula for preterm infants 2019 · Cochrane Headline outcomes only
  RR 0.72 [0.41, 1.25]
  3 studies · 489 participants
  Low