Effect of Routine Gastric Residual Aspiration on the Preterm Infant Fecal Microbiome

Lenfestey, Mary; Li, Nan; Gauthier, Josée; Winglee, Kathryn; Fodor, Anthony A.; Zeng, Ke; Jobin, Christian; Neu, Joseph; Parker, Leslie A.

doi:10.1055/a-1877-6306

Cited by 2 publications

(1 citation statement)

References 13 publications

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“…This is because frequent aspiration of gastric residue may cause gastric mucosal damage and intestinal bleeding [ 36 ]. As well as adversely affecting the protective microbiota, indirectly leading to the overgrowth of pathogenic bacteria [ 37 ]. Therefore, we need to focus on the effect of routine pre-feeding suctioning practices on the effectiveness of their interventions; however, the studies included in this paper did not detail whether the routine pre-feeding aspiration of gastric fluid was performed after olfactory and gustatory stimulation interventions.…”

Section: Discussionmentioning

confidence: 99%

Effects of olfactory and/or gustatory stimuli on feeding of preterm infants: A systematic review and meta-analysis

Zhang,

Lu,

et al. 2024

PLoS ONE

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Aim To evaluate the effect of olfactory and/or gustatory stimulation interventions on feeding outcomes in preterm infants. Methods We conducted systematic searches across various academic databases, including PubMed, Embase, Web of Science, the Cochrane Library, the Chinese Biomedical Literature Service System, China National Knowledge Infrastructure, the Wanfang Database, and the Wipu Database. These searches aimed to identify randomized controlled trials investigating the impact of olfactory and/or gustatory stimulation on preterm infants. The search period spanned from the inception of the databases until December 2022. Two independent evaluators autonomously reviewed the literature, extracted pertinent data, assessed the quality of the included studies, and conducted a meta-analysis using RevMan 5.3 software. Results A total of 7 randomized controlled trials or quasi-experimental studies were included, with a total of 871 participants. Olfactory and gustatory stimulation demonstrated a reduction in the time to full enteral feeds in preterm infants when compared to usual care (MD = -1.60 days; 95% CI = -2.31, -0.89; p<0.0001). No substantial evidence was identified regarding the influence of olfactory and gustatory stimulation on the duration of gastric tube placement, length of hospitalization, incidence of necrotizing enterocolitis, or occurrence of spontaneous bowel perforation in preterm infants. Conclusions Olfactory and gustatory stimulation show potential benefits for preterm infants. However, due to the low to very low level of certainty associated with the available data, our ability to assess the effects is limited. Further trials and studies are essential to enhance our understanding of the mechanisms and effectiveness of olfactory and gustatory stimulation therapies.

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Section: Discussionmentioning

confidence: 99%

Effects of olfactory and/or gustatory stimuli on feeding of preterm infants: A systematic review and meta-analysis

Zhang,

Lu,

et al. 2024

PLoS ONE

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Influence of gastric residual assessment in preterm neonates on time to achieve enteral feeding (the GRASS trial)—Multi-centre, assessor-blinded randomised clinical trial

Branagan,

Murphy,

O’Sullivan

et al. 2024

Eur J Pediatr

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Purpose Gastric residual measurement is routinely performed in premature infants prior to feeding despite a lack of evidence of benefit. We aimed to evaluate if the exclusion of routine gastric residual measurement and evaluation has an impact on the time taken to achieve full enteral feeding in preterm neonates. Methods International multi-centre randomised controlled trial. Clinically stable, appropriate for gestational age infants between 26+0 and 30+6 weeks of gestation and less than 1.5 kg birth weight were eligible. Infants were randomised to the intervention arm (no monitoring of gastric aspirates) or control arm (routine care). Primary outcome was the achievement of enteral feeds of 100 ml/kg/day by day 5 of life. Results Ninety-five infants were recruited with 88 included in an intention-to-treat analysis, 45 in the intervention arm and 43 in the control arm. There was no imbalance in baseline characteristics. Thirty-three (73.3%) infants in the intervention group and 32 infants (74.4%) in the control group reached full feeds by day 5 of life (p = 0.91) with no difference in median time to full feeds. There were no statistically significant differences in survival or the major morbidities of prematurity. Conclusion: There was no difference in time to attainment of enteral feeds of 100 ml/kg/day in premature infants when gastric residuals were not monitored. In the absence of a clinical benefit to routine monitoring, it may be appropriate to discontinue this practice and only monitor residuals when clinical concern of feeding intolerance or gastrointestinal pathology arises in this group of patients. Trial registration: NCT03111329—https://clinicaltrials.gov/. Registered 06/04/2017. What is Known:• Previous randomized trials have shown little benefit to the performance of routine assessment of gastric residuals in preterm infants. Despite this, they continue to be performed due to concerns from observational data regarding development of NEC. Meta-analysis to date has failed to answer the question regarding NEC. What is New:• In very low birth weight infants who are fed using modern feeding practice of faster feed advancement, to minimize use of central access and parenteral nutrition, exclusion of routine checks of gastric residuals did not increase the proportion of infants reaching full enteral feeds by day 5. No harm was seen when residual checks were not performed.• In the absence of a clinical benefit to the routine performance of gastric residuals in very low birth weight infants, it may be appropriate to discontinue their use and instead check residuals when clinical concern of pathology arises.

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Effect of Routine Gastric Residual Aspiration on the Preterm Infant Fecal Microbiome

Cited by 2 publications

References 13 publications

Effects of olfactory and/or gustatory stimuli on feeding of preterm infants: A systematic review and meta-analysis

Effects of olfactory and/or gustatory stimuli on feeding of preterm infants: A systematic review and meta-analysis

Influence of gastric residual assessment in preterm neonates on time to achieve enteral feeding (the GRASS trial)—Multi-centre, assessor-blinded randomised clinical trial

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