# The role of bovine colostrum in feeding intolerance in preterm neonates: a systematic review and meta-analysis of randomized controlled trials

## TL;DR

This study reviews whether bovine colostrum helps reduce feeding problems in preterm infants but finds limited evidence for its effectiveness.

## Contribution

A systematic review and meta-analysis of RCTs on bovine colostrum in preterm neonates, highlighting potential performance bias.

## Key findings

- Bovine colostrum was associated with reduced feeding intolerance but with low heterogeneity.
- No significant effects were found for necrotizing enterocolitis or time to full enteral feeding.
- The results suggest potential performance bias due to lack of blinding in trials.

## Abstract

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, available clinical trials provide inconsistent evidence regarding its efficacy. Therefore, this study aimed 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.

We searched five databases for randomized controlled trials (RCTs) on bovine colostrum (BC) use in preterm neonates from their inception to 8 July 2025. Outcomes included feeding intolerance, necrotizing enterocolitis (NEC), and time to full enteral feeding to 120 mL/kg/d (TFF120). Data were analyzed using RevMan 5.3.

A total of four RCTs (670 infants) were included in this study. 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.

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.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251102646, identifier CRD420251102646.