Rationale: Many preterm infants otherwise ready for discharge remain hospitalised while they transition from gavage to full sucking feeds. Early discharge of stable preterm infants still requiring gavage feeds may have some benefits: it could reduce separation of parents and infants and reduce costs to the healthcare system and families compared with discharge home when on full sucking feeds. Potential disadvantages of early discharge include increased care burden for the family and the risk of complications related to gavage feeding. This is an update of a review first published in 2003 and last updated in 2015.
Objectives: To assess the effectiveness and safety of early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds compared with later discharge when full sucking feeds have been established.
Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, and trial registries up to May 2024. We checked the reference lists of included studies and relevant systematic reviews.
Eligibility criteria: We included randomised controlled trials (RCTs) and quasi‐RCTs that enrolled infants born before 37 weeks who required no intravenous nutrition at the time of discharge. The comparison of interest was early discharge home with gavage feeds and healthcare support versus later discharge home after attainment of full sucking feeds.
Outcomes: Critical outcomes were time to reach full sucking feeds, weight gain at latest time point measured, and breastfeeding on discharge from home support or hospital. Important outcomes included infection up to discharge (e.g. respiratory infections, use of intravenous antibiotics), breastfeeding at three months after discharge, rehospitalisation up to 12 months after discharge, and composite neurodevelopmental outcome at 12 months or later.
Risk of bias: Two review authors independently screened and selected trials, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool RoB 1.
Synthesis methods: We presented dichotomous data as summary risk ratios (RRs) with 95% confidence intervals (CIs), and continuous data as mean differences (MDs) with 95% CIs. We used the GRADE approach to assess the certainty of the evidence. Included studies There were no new studies available for inclusion in this update. As in the original review, we included one quasi‐RCT (88 infants, 75 families) evaluating early discharge with home support of gavage feeding (early discharge with support) versus later discharge on full sucking feeds (later discharge) in physiologically stable preterm infants born before 37 weeks' gestation with an anticipated need for special care for at least one additional week. The study was conducted in Sweden in the 1990s.
Synthesis of results: Critical outcomes: Time to reach full sucking feeds was not reported. Early discharge with support compared with later discharge may have little or no effect on daily weight gain from trial entry to discharge from home support or hospital, but the evidence is very uncertain (MD
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