4.1. Timing and Quality of Complementary Feeding
4.2. Complementary Feeding and Clinical Outcome
4.3. Currently Available Recommendations on CF
4.4. Complementary Feeding Strategies for Infants with Oral Dysfunctions
Conflicts of Interest
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|Author, Year||Study Design||Main Findings|
|COMA report, 1994 ||Recommendation||Report of the Working Group on the Weaning Diet of the Committee on Medical Aspects of Food Policy. Recommendations for CF in term infants. Brief specific advice for preterm infants.|
|King, 2009 ||Recommendations||Proposed evidence-based guide for CF tailored to preterm infants.|
|Barachetti, 2018 ||Narrative review||Review of management, timing and health outcomes of CF in preterm infants.|
|Embleton, 2017 ||Commentary on Gupta, 2017||Commentary on the trial by Gupta et al. examining the effect of two different timings of PCF on preterm infants’ growth and clinical outcome|
|Fanaro, 2007 ||Narrative review||Review of growth and feeding issues in preterm infants after hospital discharge, with specific focus on age, type and frequency of complementary foods|
|Fanaro, 2009 ||Narrative review||Review of CF introduction in preterm infants|
|Foote, 2003 ||Narrative review||Overview of CF with a focus on low birth weight and preterm infants|
|Palmer, 2012 ||Narrative review||Available guidelines and current practices regarding PCF; evaluation of possible harms of early introduction of solid foods|
|Peters, 2018 ||Narrative review||Review on nutrition after discharge of preterm infants from the Neonatal Intensive Care Unit, with a focus on CF and allergenic foods|
|Elfzzani, 2019 ||Meta-analysis||Role of nutritional education of family members in supporting CF practices in preterm infants.|
No eligible trials looking at the impact of nutrition education of family members on PCF fulfilled the inclusion criteria of this systematic review.
|Gupta, 2016 ||Study protocol for a meta-analysis||To evaluate the effect and safety of early (at or before four months) vs. late (after four months) initiation of PCF. Both corrected and postnatal age will be examined.|
|Vissers, 2016 ||Study protocol for Vissers, 2018 ||Protocol for a systematic review on the effect of PCF timing on overweight.|
|Vissers, 2018 ||Systematic review||Effect of the timing of CF introduction (early vs. late) on the risk of overweight in preterm infants|
The five included papers (thee RCTs, two cohort studies) showed conflicting results: two RCTs → no significant difference in BMI Z-score between the intervention groups at 12 months of age; one RCT → higher rate of length growth until 12 months in the preterm weaning strategy-group compared with the current best practices; one observational study → inverse relationship between timing of CF and length and weight Z-scores.
|Chawla, 2019 ||Editorial commentary||An overview regarding the CF strategies for preterm infants with bronchopulmonary dysplasia|
|Dusick, 2003 ||Narrative review||A review regarding the nutritional management of infants with dysphagia.|
|Baldassarre, 2018 ||Observational trial||Survey of PCF among Italian primary care pediatricians.|
Heterogeneity in PCF timing (based on infants age, and/or neurodevelopment and/or body weight), quality, and prescription of vitamin D and iron supplements.
|Braid, 2015 ||Observational trial||Analysis of factors associated with early CF in preterm infants from the Early Childhood Longitudinal Study, Birth Cohort (2001–2002).|
Higher odds of early CF in preterm vs. term infants. The lower the GA, the higher the odds. Predictors of early CF different in preterm compared to term infants.
|Cleary, 2020 ||Observational trial||Structured interviews on infant feeding practices, growth and medical status in term and preterm infants. Preterm infants received CF earlier than term infants; lower maternal education and male gender were associated with early CF among preterm infants.|
|Fanaro, 2007 ||Observational trial||Survey of CF practices in an Italian region. Wide variation in timing (corrected vs. chronological age) and quality of CF (low energy and low protein often offered as first solid food, with negligible iron and zinc content).|
|Fewtrell, 2003 ||Pooled RCTs results||Data from >2000 infants from seven prospective UK RCTs, comparing the age at CF in term appropriate size for gestational age (AGA), small for gestational age, and preterm infants.|
Preterm infants were significantly more likely to receive solids at both six and twelve weeks after term than term AGA infants. Factors associated with earlier CF were formula feeding and maternal smoking.
|Giannì, 2018 ||Observational trial||Evaluation of practices related to CF in a cohort of Italian late preterm infants.|
Late preterm infants were weaned at almost six months of age and received low energy and/or low protein-dense foods as first solid foods.
|Gupta, 2017 ||RCT||RCT comparing the initiation of CF at four vs. six months CA in preterm infants in India.|
No difference was documented in the primary aim (weight-for-age z score at 12 months CA) between groups, but a higher rate of hospital admission was recorded in the four-month group.
|Hüb, 2020 ||Observational trial||Evaluation of the association between sucking patterns, assisted spoon feeding, and chewing skills in preterm infants. Sucking patterns were evaluated at 34, 37, and 44 weeks CA, assisted spoon feeding was evaluated at six, nine, and 12 months PMA, and chewing was evaluated at 9, 12, and 24 months PMA.|
|Longfier, 2016 ||Observational trial||Analysis of facial expression and infant’s temperament in response to the introduction of CF in preterm vs. term infants.|
Infants born preterm expressed fewer negative emotions in response to first CF than infants born full-term and showed a familiarization effect with the frequency of negative expressions decreasing after tasting the second spoon, regardless of infant age, type of food and order of presentation.
|Marriott, 2004 ||RCT||RCT aimed at comparing a “preterm weaning strategy (PWS)” vs. conventional CF management in preterm infants.|
Infants receiving CF according to PWS showed higher standard deviation length scores and length growth velocity, and higher intake of energy, protein, and carbohydrate, and iron during follow up.
|Menezes, 2018 ||Observational trial||Structured interviews administered to parents of preterm infants to highlight feeding difficulties during CF.|
Most infants had at least one defensive behavior at mealtime, including refusal to open their mouth, food selectivity, and feeding refusal.
|Morgan, 2004 ||Pooled RCTs results||Data from >1600 term and preterm infants from five prospective UK RCTs, comparing early (<12 weeks) vs. late (>12 weeks) introduction of CF.|
As for preterm infants, those weaned before 12 weeks showed slower gain in weight, length, and head circumference between 12 weeks and 18 months than those weaned after 12 weeks; by 18 months, there were no significant differences in size between the two groups. No effect of CF on other clinical outcomes was observed
|Morgan, 2004 ||Observational trial||Evaluation of CF-related risk factors for eczema at 12 months post-term in preterm infants.|
Identified risk factors were the introduction of ≥4 solid foods by or before 17 weeks post-term, male gender, having atopic parents who introduced solid foods before 10 weeks post-term or having at least one atopic parent.
|Morgan, 2016 ||Observational trial||Cohort study performed by means of postal questionnaires aimed at describing feeding patterns and mothers’ perceptions of desirable feeding practices in preterm infants in England.|
CF was introduced at a median age of 17 postnatal weeks. Mothers perceived a high-fiber, low-fat diet as important for their infants. A high calorie intake was not given the correct importance by 25% of mothers.
|Norris, 2002 ||Observational trial||Structured interviews conducted in the UK to evaluate factors associated with PCF.|
Almost half of the infants received early CF, both considering corrected and chronological age. Differences between human milk- and formula-fed infants in the timing of CF were documented.
|Rodriguez, 2018 ||Observational trial||Cross-sectional study aimed at examining the relationship between feeding practices and weight gain.|
Almost half infants received CF before four months CA. A greater weight gain was documented in infants receiving early CF, but the results were considered of little clinical relevance.
|Sanchez, 2016 ||Observational trial||Evaluation of oro-motor feeding at 12 months’ CA in children born before 30 weeks’ GA compared with term-born peers by observational assessment.|
Infants born before 30 weeks presented with higher odds of oro-motor feeding problems at 12 months’ CA than their term-born peers (OR 2.21; 95% CI 1.55–3.16). Neonatal surgery was associated with increased odds of feeding difficulties in children born before 30 weeks (OR 11.66; 95% CI 1.56–87.23).
|Spiegler, 2015 ||Observational trial||Longitudinal analysis of timing of CF introduction in German VLBW infants, risk factors for early introduction of CF, and relationship between PCF timing and growth at 2 years of age.|
Average age at introduction of CF: 3.5 months post-term. Low GA at birth = early PCF introduction. Age at introduction of CF influenced by intrauterine growth restriction, GA at birth, maternal education and a developmental delay perceived by the parents. No negative effect of early introduction of CF on length and weight at two years of age.
|Yrjänä, 2018 ||Observational trial||Evaluation of the association between very early introduction of semi-solid foods on food allergies or atopic dermatitis. Preterm infants were introduced safely to semi-solid foods earlier than term infants but did not show an increased risk for food allergies or atopic dermatitis.|
|Zielinska, 2019 ||Observational trial||Cross-sectional study investigating factors for early CF in Poland and Austria.|
Preterm birth was identified among significant risk factors for early CF, together with lower maternal age and educational level, absence of breastfeeding and formula feeding after hospital discharge.
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