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.

Reply — Gastric Residuals, Feeding Intolerance, and Nectrotizing Enterocolitis in Preterm Infants

“…Although they found no statistically significant differences between groups, infants who did not undergo routine evaluation of gastric residual obtained full feedings (150 mL/kg/d) 6 days early and had 6 fewer days of central venous access. 4 In addition, we are currently enrolling participants in a larger randomized clinical trial to determine both the risks and benefits of performing routine gastric residual evaluation in very low birth weight infants.…”

Nutrición intrahospitalaria del prematuro. Recomendaciones de la Rama de Neonatología de la Sociedad Chilena de Pediatría

“…No medir residuos es una posibilidad sugerida, o establecer protocolos de manejo del residuo 36 . La presencia de residuos no anticipa ni se asocia al riesgo de ECN [35][36][37] . Grupos europeos inician aporte enteral muy lento: cada 6 h, aumentando la frecuencia diariamente.…”

Gastric Residual Volume Linked to Gastric Fluid pH in Infants with Very Low Birth Weight

“…GRV is the volume of feeding extracted from the preterm infant's stomach via the orogastric tube to determine undigested volume before administering the next feeding [3,12]. Despite Although studies showing that GRV is not correlate with the ability to reach full-feeding volumes and that variations exists for the exact GRV providers tolerate before stopping feeds, providers continue to use GRV as a clinical manifestation of feeding intolerance [5]. The GRV most agreed upon was > 50% of prior feed volume.…”

“…However, feeding intolerance (FI) is the most common gastrointestinal condition seen in infants with very low birth weight (VLBW) during enteral nutrition and usually results in withholding of enteral nutrition for a period that negatively affects the infants' growth process [3]. FI is usually defined as gastric residual volume (GRV) > 50% of the previous feeding volume; emesis, abdominal distension, or both of these symptoms; and a decrease, delay, or discontinuation of enteral feedings [3][4][5][6]. Gastric residuals (GRs) are evaluated in preterm infants who are being fed via an orogastric or nasogastric tube as a putative indicator of FI or as an early symptom of necrotizing enterocolitis [7][8].…”