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

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, 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. Method: 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. Result: = 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. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251102646, identifier CRD420251102646.