Enteral insulin for full enteral feeding in preterm infants: A systematic review and meta-analysis.

Background: Recent studies have demonstrated that recombinant human insulin (rh-insulin) can shorten the time of full enteral feeding (FEF) and is relatively safe in preterm infants. However, there is no consensus on the safety and effectiveness of enteral insulin. The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of rh-insulin with increased statistical power.

Methods: Our team systemically searched the PubMed, Embase, Web of Science, and Cochrane Library databases for related studies from inception to April 16th, 2023. Time to FEF and wean-off parenteral nutrition were the primary and secondary measured outcomes, reported serious adverse events were also combined.

Results: Three studies including 292 patients in total were pooled for analysis. Meta-analysis showed statistically significant differences in the time to achieve FEF [weighted mean difference = -3.88, 95% CI (-5.81, -1.95), P < .0001] and wean-off parenteral nutrition [weighted mean difference = -2.82, 95% CI (-5.35, -0.29), P = .03] between the rh-insulin group and the control group. Regarding reported serious adverse events, there were no statistical differences [risk ratio = 0.72, 95% CI (0.47, 1.11), P = .13].

Conclusion: rh-insulin can effectively improve the digestive function of preterm infants mainly manifested in shortening the time to FEF, and also the time to wean-off parenteral nutrition, it will not increase the incidence of serious adverse events. It seems to be a safe and effective method of worthing more high-quality and large-scale randomized controlled trials to provide more robust evidence.