The Significance of Gastric Residuals in the Early Enteral Feeding Advancement of Extremely Low Birth Weight Infants

Mihatsch, Walter; Schoenaich, Patrik von; Fahnenstich, Hubert; Dehne, Norma; Ebbecke, Hartmut; Plath, C; Stockhausen, Hans-Burkhardt Von; Muche, Rainer; Franz, Axel; Pohlandt, Frank

doi:10.1542/peds.109.3.457

Cited by 152 publications

(151 citation statements)

References 15 publications

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“…Establishment of enteral nutrition is a significant challenge for premature infants in the neonatal intensive care unit (NICU) [1,2,3]. Spontaneous meconium evacuation is prolonged in premature infants and meconium retention seems to be associated with a delay in establishing enteral feeds [4,5].…”

Section: Introductionmentioning

confidence: 99%

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

et al. 2017

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Background: Meconium retention is associated with feeding intolerance. Trials using glycerol and Gastrografin to expedite the evacuation of meconium have failed to generate clinically valid results for efficacy and safety. Objective: We assessed the feasibility of aggressive meconium evacuation with saline rectal washout (RW) in very-low-birth-weight infants to reduce the time it took them to reach full enteral feeds. Methods: We conducted an open-label, pilot, randomized controlled trial (RCT) (birth weight stratified, i.e., to 750-999 g and 1,000-1,500 g) of early aggressive meconium evacuation with twice-daily normal saline RW compared to conventional management with glycerin suppositories (GS), until full enteral feeds (110 mL/kg/day) were reached. Primary outcome was time to reach full enteral feeds. Safety, process, and secondary efficacy outcomes were also evaluated. Results: Sixty-one infants were randomized, 28 to RW and 33 to GS. The process and feasibility outcomes were met. RW was found to be safe; none of the RW-randomized infants developed necrotizing enterocolitis (≥ stage II) or complications secondary to RW. Evidence of efficacy was supported: in the 750-999 g stratum (n = 15), the median time to full enteral feeds was shorter with RW (11.0 days, 95% CI: 10.4-11.6) than with GS (15.6 days, 95% CI: 13.0-18.2) by a reduction of 4.6 days (p = 0.027). In the 1,000-1,500 g stratum (n = 46), there was no evidence of benefit: RW 10.2 days (95% CI 8.3-12.1) and GS 10.1 days (95% CI 9.3-10.9, p = 0.304). Conclusion: Our protocol was feasible and an adequately powered RCT is required to confirm the findings of this trial.

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Section: Introductionmentioning

confidence: 99%

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

et al. 2017

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“…Similarly, the color of the GRV (green, milky, clear) did not predict feeding intolerance. 28 Nonetheless, the volume of feeding on day 14 did correlate with a higher proportion of episodes of zero GRVs and with predominantly milky gastric residuals. Thus, isolated findings related to gastric emptying alone should not be the sole criteria in initiating, advancing, or withholding feeds.…”

Section: Initiation and Advancement Of Enteral Feedingsmentioning

confidence: 78%

“…According to Ziegler, gastric residuals are very frequent in the early neonatal period and are virtually always benign, that is, not associated with NEC. 27 A 2002 study 28 demonstrated that in ELBW infants, excessive gastric residual volume (GRV) either determined by percent of the previous feed or an absolute volume (>2 or >3 mL) did not necessarily affect feeding success as determined by the volume of total feeding on day 14. Similarly, the color of the GRV (green, milky, clear) did not predict feeding intolerance.…”

Section: Initiation and Advancement Of Enteral Feedingsmentioning

confidence: 99%

Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

Adamkin

2005

J Perinatol

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“…There is no literature consensus about the amount of residue that is clinically relevant. [32][33][34] Hence, the importance of gastric residuals as a diagnostic sign is declining, since it can be considered more a sign of GI maladaptation than of insurgence of NEC and therefore it is not possible to conclude that bolus feeding exerts a better impact on feeding tolerance than continuous feeding.…”

Section: Resultsmentioning

confidence: 99%

Enteral nutrition for preterm infants: by bolus or continuous? An update

Bozzetti

Tagliabue

2017

Pediatr Med Chir

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Optimization of nutritional management of preterm infants is crucial for achievement of their long-term health. Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Due to the lack of ability of preterm infants to coordinate suckling, swallowing, and breathing, tube feeding is necessary for most infants less than 1500 g to ensure sufficient feeding tolerance, to support optimal growth and to reduce the risk of aspiration. Therefore, feeding by orogastric or nasogastric tube using either continuous or intermittent bolus delivery of formula or human milk is common practice for these infants. Theoretical risks and benefits of both continuous nasogastric milk feeding and intermittent bolus milk feeding have been proposed. According to the literature, continuous nutrition could be preferred in smaller infants (as those with a birthweight below 1250 g) or hemodynamically impaired infants; in stable growing infants nutrition can be administered intermittently as in healthy term infants. IntroductionApproximately 8% of infants are born with a weight at birth less than 2.5 kg. 1 These infants face uncertain futures, ranging from insufficient postnatal growth to compromised neurodevelopmental outcomes. 2 Thus, optimization of their nutritional management is crucial for achievement of their long-term health and wellbeing. There is a correlation between the neurocognitive outcome and growth, for this reason an adequate nutrition is essential for the optimal growth and health. Most of severe preterm infants are discharged weighing less than the tenth percentile for age despite improvements in their nutritional management. 3 Some of them remain small to adulthood and exhibit adverse long-term developmental outcomes including learning impairments and reduced work capacity. 4,5 Because growth failure of low birth weight (LBW) infants has been attributed, in part, to the provision of inadequate levels of protein and energy, more aggressive nutritional support is now being advocated. 6 Evidence suggests that this approach is justified because early provision of amino acids to extremely LBW infants is associated with improved growth; 7 moreover provision of adequate amount of amino acid increases whole body protein synthesis and accretion rates in LBW infants. 8 Parenteral feeding allows rapid nutrition when enteral nutrition is not possible due to respiratory problems, limited gastric capacity, reduced intestinal mobility, and a perceived risk for necrotizing enterocolitis. 6 When an infant is medically stable, minimal enteral feeding is provided to prime the intestine and gradually the infant is moved from parenteral to enteral feeding until achievement of full enteral feedings.Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Moreover, enteral feedin...

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The Significance of Gastric Residuals in the Early Enteral Feeding Advancement of Extremely Low Birth Weight Infants

Cited by 152 publications

References 15 publications

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

Enteral nutrition for preterm infants: by bolus or continuous? An update

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