SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
The role of bovine colostrum in feeding intolerance in preterm neonates, a systematic review and meta-analysis of randomized controlled trial
Provisionally accepted
- Suzhou Ninth People's Hospital, Suzhou, China
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Background: Feeding intolerance is common in preterm infants and may lead to poor weight gain and prolonged hospitalization. Bovine colostrum, owing to its rich content of bioactive components such as immunoglobulins, lactoferrin, and growth factors, has been suggested to reduce feeding intolerance and promote gut maturation in preterm infants; however, the available clinical trials provide inconsistent evidence regarding its efficacy. Therefore, the aim of this study was to conduct a systematic review and meta-analysis to evaluate the effects of bovine colostrum supplementation on feeding intolerance, necrotizing enterocolitis, and time to full enteral feeding in preterm infants. Method: We searched five databases for RCTs on BC use in preterm neonates up to July 8, 2025. Outcomes included feeding intolerance, necrotizing enterocolitis (NEC), and time to full enteral feeding to 120ml/kg/d (TFF120). Data were analyzed using RevMan 5.3. Result: Four RCTs (670 infants) were included. BC supplementation was associated with a lower incidence of feeding intolerance (RR = 0.76; 95% CI: 0.61–0.94) with low heterogeneity (I² = 2%). However, this effect should be interpreted with caution, as the lack of blinding in the included trials may have introduced performance bias. No significant effects were observed for NEC or TFF120, and the evidence regarding adverse events was limited. Conclusion: BC cannot be recommended for preterm infants based on current evidence. The observed reduction in feeding intolerance is likely due to performance bias, with no proven benefit for NEC or TFF120. Registration Details: PROSPERO (CRD420251102646): https://www.crd.york.ac.uk/PROSPERO/view/CRD420251102646 Implications for Nutrition: Findings will inform nutrition of an ideal environment for the feeding intolerance for newborn.
Keywords: Feeding intolerance, Bovine colostrum, Preterm neonate, NEC, TFF120, Systematic review, Meta-analysis
Received: 18 Jul 2025; Accepted: 07 Nov 2025.
Copyright: © 2025 Yao, Zheng, Zhang, xu and Zhuang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jianbo Zhuang, 943644700@qq.com
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