Enteral Feeding Practices in the NICU

Gregory, Katherine E.; Connolly, Teresa C.

doi:10.1097/anc.0b013e3182425aab

Cited by 49 publications

(21 citation statements)

References 44 publications

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“…Feeding guidelines are becoming common in the NICUs to balance the benefits of EN with the risk of NEC in high-risk infant populations. (17, 18) Minimal EN regimens (trophic feeding) are often used in high risk patients, however broad ranges in trophic volumes (5-20 ml/kg/day) make studies of feeding practices difficult to compare to determine the ideal volume and duration of minimal EN. (19) A study of premature infants showed early feeding (within 48 hours of birth) improved feeding tolerance and decreased exposure to PN, without an increase in NEC.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure–Associated Liver Disease in Surgical Infants

Shores

Alaish²,

Aucott³

et al. 2018

The Journal of Pediatrics

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Section: Discussionmentioning

confidence: 99%

Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure–Associated Liver Disease in Surgical Infants

Shores

Alaish²,

Aucott³

et al. 2018

The Journal of Pediatrics

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“…Increasingly, this routine practice is being challenged in neonatal intensive care [ 10 , 17 , 26 ] PICUs [ 33 ] and across critical care generally [ 4 , 9 , 15 , 18 , 30 ]. The incidence of gastrointestinal complication of vomiting was higher in the routine GRV measured group.…”

Section: Discussionmentioning

confidence: 99%

Routine gastric residual volume measurement and energy target achievement in the PICU: a comparison study

et al. 2017

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Critically ill children frequently fail to achieve adequate energy intake, and some care practices, such as the measurement of gastric residual volume (GRV), may contribute to this problem. We compared outcomes in two similar European Paediatric Intensive Care Units (PICUs): one which routinely measures GRV (PICU-GRV) to one unit that does not (PICU-noGRV). An observational pilot comparison study was undertaken. Eighty-seven children were included in the study, 42 (PICU-GRV) and 45 (PICU-noGRV). There were no significant differences in the percentage of energy targets achieved in the first 4 days of PICU admission although PICU-noGRV showed more consistent delivery of median (and IQR) energy targets and less under and over feeding for PICU-GRV and PICU-noGRV: day 1 37 (14–72) vs 44 (0–100), day 2 97 (53–126) vs 100 (100–100), day 3 84 (45–112) vs 100 (100–100) and day 4 101 (63–124) vs 100 (100–100). The incidence of vomiting was higher in PICU-GRV. No necrotising enterocolitis was confirmed in either unit, and ventilator-acquired pneumonia rates were not significantly different (7.01 vs 12 5.31 per 1000 ventilator days; p = 0.70) between PICU-GRV and PICU-noGRV units. Conclusions: The practice of routine gastric residual measurement did not significantly impair energy targets in the first 4 days of PICU admission. However, not measuring GRV did not increase vomiting, ventilator-acquired pneumonia or necrotising enterocolitis, which is the main reason clinicians cite for measuring GRV. What is known: • The practice of routinely measuring gastric residual volume is widespread in critical care units • This practice is increasingly being questioned in critically ill patients, both as a practice that increases • The likelihood of delivering inadequate enteral nutrition amounts and as a tool to assess feeding tolerance What is new: • Not routinely measuring gastric residual volume did not increase adverse events of ventilator acquired pneumonia, necrotising enterocolitis or vomiting. • In the first 4 days of PICU stay, energy target achievement was not significantly different, but the rates of under and over feeding were higher in the routine GRV measurement unit.

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“…A survey conducted among neonatal nurses in the United States (US) and in Canada documented that PDA pharmacological treatment is perceived as one of the leading contraindications to enteral feeding in preterm infants [63]. However, whether withholding feeding during pharmacological PDA closure could help preventing the occurrence of GI complications in infants with a hs-PDA is still a matter of debate among neonatologists.…”

Section: Association Between Pda Feeding Practices and Gi Outcomesmentioning

confidence: 99%

To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus

et al. 2019

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The management of enteral feeds in preterm infants with a hemodynamically significant patent ductus arteriosus (hs-PDA) is a major challenge for neonatologists due to the fear of gastrointestinal (GI) complications. This review aims to analyze the available evidence on the complex relation between the presence and management of PDA, enteral feeding practices, and GI outcomes in the preterm population. There is limited evidence, based on small and heterogeneous trials, that hs-PDA may affect the splanchnic hemodynamic response to enteral feeds. While the presence of PDA seems a risk factor for adverse GI outcomes, the benefits of feeding withholding during pharmacological PDA treatment are controversial. The lack of robust evidence in support of or against a timely feeding introduction or feeding withholding during pharmacological PDA closure in preterm neonates does not allow to draw any related recommendation. While waiting for further data, the feeding management of this population should be carefully evaluated and possibly individualized on the basis of the infants’ hemodynamic and clinical characteristics. Large, multicentric trials would help to better clarify the physiological mechanisms underlying the development of gut hypoperfusion, and to evaluate the impact of enteral feeds on splanchnic hemodynamics in relation to PDA features and treatment.

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Enteral Feeding Practices in the NICU

Cited by 49 publications

References 44 publications

Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure–Associated Liver Disease in Surgical Infants

Postoperative Enteral Nutrition Guidelines Reduce the Risk of Intestinal Failure–Associated Liver Disease in Surgical Infants

Routine gastric residual volume measurement and energy target achievement in the PICU: a comparison study

To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus

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