NON-PHARMACOLOGICAL INTERVENTIONS FOR FEEDING AND GROWTH IN PRETERM NEONATES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIAL

Abstract

Feeding intolerance (FI) delays nutritional advancement, growth, and discharge readiness in preterm neonates (<37 weeks' gestation). Non-pharmacological interventions (NPIs) - including oral stimulation, non-nutritive sucking (NNS), premature infant oral motor intervention (PIOMI), abdominal massage, KMC, and multisensory stimulation - are increasingly applied as safe, low-risk strategies to support feeding and growth in neonatal intensive care units. This systematic review and meta-analysis evaluated randomized controlled trial evidence for NPIs on feeding tolerance, oral feeding progression, growth, and hospitalization outcomes in preterm neonates. Eligible studies published between 2020 and 2026 were identified through database and manual reference searching. Continuous outcomes were summarized as mean differences (95% Confidence Interval); dichotomous outcomes as risk ratios. Missing variance data were not imputed. Twenty-one eligible RCTs were included, encompassing oral stimulation, PIOMI, NNS, abdominal massage, I Love You massage, Chinese pediatric Tuina, prone positioning, Kangaroo mother care (KMC), and multistimulation. Pooled analysis demonstrated that NPIs reduced GRV by 3.07 mL (95% CI −3.33 to −2.81; I² = 0%). KMC significantly reduced FI events (RR = 0.22, 95% CI 0.08–0.63), and abdominal massage reduced post-feeding abdominal circumference. Oral-motor interventions favored earlier feeding readiness, faster transition to full oral feeding, and shorter hospitalization, though several outcomes were not poolable. NPIs are effective supportive strategies for improving feeding outcomes in preterm neonates. Evidence is strongest for gastric residual volume (GRV) and FI events; standardized outcome reporting across future trials remains necessary.