Routine monitoring of gastric residual for prevention of necrotising enterocolitis in preterm infants

Does prefeed gastric residual evaluation impair enteral nutrition intake in very preterm infants?

“…Overall, despite limitations, the study design is appropriate. Results are consistent with other literature suggesting that omitting prefeed gastric residual evaluation improves nutritional outcomes without increasing complications . Given the importance of infant nutrition, it would seem reasonable to omit prefeed gastric residuals in clinical practice for the population studied here.…”

“…Evaluation aims to detect feed intolerance that might be associated with early NEC, and to reduce aspiration and VAP. However, evidence behind this practice is limited . It may reduce nutritional intake when feeds are stopped based on subjective assessments .…”

“…However, evidence behind this practice is limited . It may reduce nutritional intake when feeds are stopped based on subjective assessments . This is concerning because adequate nutrition is essential for growth and neurodevelopment …”

“…One strength is that the primary outcome is adequately powered. However, secondary outcomes are not, and NEC is arguably the most important outcome . Furthermore, evaluating the primary outcome over 6 weeks may not be a valid measure; the greatest nutritional deficits usually occur in the first 2 weeks after birth.…”

“…Also, 26.1% of the ‘No Residual’ group had gastric aspirations performed inadvertently or due to gastro‐intestinal symptoms. Furthermore, medications may have impacted feed tolerance . Lastly, only using human milk means that the results may not be generalisable to formula‐fed infants, and some might argue that omitting gastric aspiration in nasogastric tube placement is unsafe.…”