The value of routine evaluation of gastric residuals in very low birth weight infants

Abstract

Objective: Little information exists regarding gastric residual (GR) evaluation prior to feedings in premature infants. The purpose of this study was to compare the amount of feedings at 2 and 3 weeks of age, number of days to full feedings, growth and incidence of complications between infants who underwent RGR (routine evaluation of GR) evaluation versus those who did not.

Study design: Sixty-one premature infants were randomized to one of two groups. Group 1 received RGR evaluation prior to feeds and Group 2 did not.

Result: There was no difference in amount of feeding at 2 (P=0.66) or 3 (P=0.41) weeks of age, growth, days on parenteral nutrition or complications. Although not statistically significant, infants without RGR evaluation reached feeds of 150 ml kg(-1) per day 6 days earlier and had 6 fewer days with central venous access.

Conclusion: RESULTs suggest RGR evaluation may not improve nutritional outcomes in premature infants.

Conflict of interest statement

Conflict of Interest: Dr Neu claims disclosures but no conflict of interest. Disclosures include Scientific Advisory Panel: Medela and Mead Johnson, Consultant: Infant Microbial Therapeutics, Lecturer: Nestle, Abbott, Mead Johnson, and Danone. Drs Li, Shuster, Neu and Beth Talaga declare no conflict of interest.

Figures

Figure 1

Feeding algorithm. aIf waiting for breast milk (BM) availability, initiation of feedings should not be delayed by more than 24 h. a,bIn infants with a low Apgar score < 3, hypoxic-ischemic encephalopathy stage 2 or 3, or hypotensive, consider holding off on initiating feeding for 48 h or provide lower volumes. cFor infants receiving trophic feedings, expect residuals to be the same amount as feeding volume. Nonbilious residuals should be refed as part of total feeding volume. dCurrently, in most NICUs, ampicillin and gentamicin would be first-line antibiotics. Metronidazole administration should be considered in severe cases or if surgery is needed. May consider screening laboratory results (CBC/CRP) and/or scheduling frequent KUBs. If abnormal, treat as NEC. Adapted from Torrazza and Neu. CBC, complete blood count; CRP, C-reactive protein; IVF, intravenous fluids; KUB, abdominal X-ray; NG, nasogastric; OG, orogastric.