Evaluation of Potential Factors Predicting Attainment of Full Gavage Feedings in Preterm Infants

Abstract

Background: The clinical measures of gastric residuals and abdominal distention are often used to guide feeding in preterm infants, but there are few data demonstrating their usefulness. Similarly, techniques are now available to investigate gastrointestinal (GI) function noninvasively and safely, but their ability to predict attainment of full gavage feedings and/or feeding volume in preterm infants is unclear. Objective: We sought to determine prospectively the potential relationships of attainment of full gavage feedings and feeding volume with clinical measures and noninvasive GI tests. Methods: Fifty preterm infants were followed prospectively. Daily tally was taken of gavage feeding intake, gastric residual volumes (GRVs; milliliters per day, number of GRVs >50% of the previous feeding volume, and number of GRVs >2 ml/kg), and abdominal distention. Infants underwent repeated measurement of lactase activity, GI permeability, fecal calprotectin concentration, and gastric emptying. Results: The number of GRVs >2 ml/kg tended to decrease with postnatal age (p = 0.06). Lactase activity and feeding volume in milliliters per kilogram per day prior to achieving full feedings were correlated (p = 0.007, β = 0.164). There was no correlation between feeding outcomes and GRV (ml/day), GRV >50%, GRV >2 ml/kg, small bowel, colonic, or whole bowel permeability, fecal calprotectin concentration, gastric emptying, or abdominal distention. Conclusions: GRV is unreliable in predicting attainment of full gavage feeding. Lactase activity is related to feeding volume. However, other noninvasive GI tests utilized were not predictive. These data cast doubt upon the utility of GRV in guiding feeding therapy. Randomized trials of different GRV management protocols are needed.

Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study

“…In general, what constitutes clinically significant gastric residual remains unclear, controversy also exists regarding the role of gastric residuals (Shulman et al, 2011). Observing fifty preterm infants prospectively, Shulman et al (2011) found no correlation between the gastric residue volume threshold and the feeding outcomes (Shulman et al, 2011).…”

“…Observing fifty preterm infants prospectively, Shulman et al (2011) found no correlation between the gastric residue volume threshold and the feeding outcomes (Shulman et al, 2011). However, they also indicated that a delay in attaining full feeding might be a result of various factors acting at the same time, and suggested that continuous randomized study is needed to determine whether different GRV management protocols can be used to direct feeding management (Shulman et al, 2011). Several authors have argued that the occurrence of GRV may be more an indicator of gut immaturity rather than gut dysfunction (Cobb et al, 2004;Mihatsch et al, 2002).…”

“…Clinically, it is used as a criteria to determine whether to advance, postpone or withhold feeding (Jirapaet et al, 2010;King, 2009;Shulman et al, 2011). Increased gastric residuals, emesis and abdominal distension are regarded as objective parameters of feeding intolerance (Bertino et al, 2009;Moore and Wilson, 2011) or precursors to necrotizing enterocolitis (Cobb et al, 2004;Gregory et al, 2011).…”

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

“…13–16 Shulman et al . 17 concluded that GRs were an unreliable indicator to predict attainment of full gavage feeding and there is currently no consensus regarding the volume of GRs as an indicator of feeding intolerance. 18 …”

Aspiration and Evaluation of Gastric Residuals in the Neonatal Intensive Care Unit

“…1 In an RCT of 61 very low birth weight (VLBW) infants, Torrazza et al, found that undergoing routine aspiration and evaluation of GRs delayed attainment of full feedings (150 mL/kg/d) by 6 days and Shulman et al, found no correlation between enteral nutrition outcomes and GR volume. 34,35 …”