Early introduction of oral feeding and its impact on full oral feeding and discharge in preterm infants: a systematic review protocol

Objective: This review aims to examine the impact of early introduction of oral feeding, compared with standard care, on the duration of achieving full oral feeding, postmenstrual ages at full oral feeding and discharge, and weight gain in preterm infants. Introduction: Because of their immature oral function, preterm infants are prone to feeding difficulties during hospitalization and after hospital discharge. Early introduction of oral feeding helps infants to coordinate sucking, swallowing, and respiration, thereby improving their oral feeding skills. However, early introduction of oral feeding may also contribute to respiratory adverse events; therefore, safety verification is necessary. Inclusion criteria: Early introduction of oral feeding is defined as beginning oral feeding at < 33 weeks' postmenstrual age and transitioning from tube feeding to oral feeding. The primary outcomes are the duration from the initial oral feeding to full oral feeding; postmenstrual age at full oral feeding and discharge; and weight gain. The secondary outcomes are oxygen desaturation and bradycardia. Methods: Eight databases, including MEDLINE (Ovid), CINAHL (EBSCOhost), and the Cochrane Central Register of Controlled Trials, will be used with no restrictions on language or publication year. Study selection, critical appraisal, data extraction, and data synthesis will be conducted by 2 independent reviewers according to the JBI methodology for systematic reviews. Quantitative data will be extracted and pooled in a statistical meta-analysis, if possible. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to assess the certainty of evidence.