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Table 4 Evidence quality assessment of according to the GRADE guidelines

From: Effectiveness of feeding supplementation in preterm infants: an overview of systematic reviews

First author Health outcomes Study limitation Indirectness Publication bias Imprecision Inconsistency Confidence
Pammi et al. Hospital stay ↓ -1 0 0 0 -1 low
urinary tract infection ↓ -1 0 0 0 -1 low
Morbidity: LOS ↓ -1 0 0 0 -1 low
Morbidity: Fungal sepsis ↓ -1 0 0 0 0 moderate
Howlett et al. Mortality: Neonatal death ↓ 0 0 0 0 -1 moderate
Chi et al. Days achieve full enteral feeding↓ 0 0 -1 0 -2 Very low
Hospital stay ↓ 0 0 -1 0 -2 Very low
Stool frequency ↑ 0 0 -1 -1 0 low
Morbidity: Sepsis ↓ 0 0 0 0 0 high
mortality↓ 0 0 0 0 0 high
Armannia et al. Phototherapy rate ↓ -1 0 0 -1 0 low
Hospital stay ↓ -1 0 0 -1 0 low
Stool frequency ↑ 0 0 0 0 0 high
Morbidity: Hyperbilirubina-emia ↓ -1 0 0 -1 0 low
Amissah et al. Weight ↑ -1 0 0 0 -1 low
Length ↑ -1 0 0 0 -1 low
HC↑ -1 0 0 0 -1 low
Blood urea nitrogen ↑ -1 0 0 0 -1 low
Hospital stay ↑ -1 0 0 -2 0 Very low
Amissah et al. Weight ↑ -1 -1 0 -1 0 Very low
Hospital stay ↓ -1 -1 0 -1 0 Very low
Yang et al. Length ↑ 0 0 0 0 0 high
HC ↑ 0 0 0 0 0 high
Ig-A ↑ 0 0 0 0 0 high
Ig-G ↑ 0 0 -1 -1 0 low
IL-12 ↑ 0 0 0 -1 0 moderate
Shah et al. Morbidity: NEC ↓ 0 0 -1 0 0 moderate
Aceti et al. Morbidity: LOS ↓ 0 0 0 0 0 high
Moe-Byrne et al. Days achieve full enteral feeding ↓ 0 0 -1 0 0 moderate
Moon et al. Weight ↑ 0 0 -1 0 -1 low
Length ↑ 0 0 -1 0 -1 low
AlFaleh et al. Hospital stay ↓ -1 0 0 0 -2 Very low
Days achieve full enteral feeding ↓ -1 0 -1 0 -2 Very low
NEC ↓ -1 0 -1 0 0 low
Mortality↓ -2 0 0 -1 0 Very low
Young et al. Visual acuity↑ 0 0 -1 -1 0 low
Bone mineral content (4/12 months) ↑ 0 0 -1 -1 0 low
Verner et al. Intestinal fat absorption ↑ 0 0 0 -1 -1 low
  1. LOS Late-onset sepsis; HC Head circumference; NEC Necrotizing enterocolits
  2. Study limitation: Downgraded two level to study risk of bias at two or more points. Downgraded one level to study risk of bias at one point
  3. Indirectness: Downgraded one level due to a conclusion indirectly
  4. Publication bias: Downgraded on level due to funnel plot is not symmetrical or fewer than nine studies were included
  5. Imprecision: Downgraded one level due to uncertainty about precision.
  6. Inconsistency: Downgraded one level due to included studies : 75%≤ I2 ≤100%; Downgraded two level due to included studies: 50≤ I2 < 75%