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Gastric Residuals
The Significance of Gastric Residuals in Early Enteral Feeding Advancement of Extremely Low Birth Weight Infants. Mihatsch WA, von Schoenaich P, Fahnenstich H, et al. Pediatrics (March 2002) 109: 457-9.
The objective of this study was to evaluate whether mean gastric residual volume (GRV) or green gastric residuals were significant predictors of early feeding intolerance in extremely low birth weight (ELBW; < 1000 grams) infants. Ninety-nine ELBW infants were fed following a standardized protocol (day 3-14). At 48 hours of age, milk feeding was started (12 ml/kg/day increments, 12 feedings per day). Gastric residuals were checked before each feeding and a GRV up to 2 ml / 3 ml in infants <750 g / > 750 g was tolerated. In cases of increased GRV, the amount of the residual was subtracted from the subsequent feeding. The feedings were advanced by 12 ml/kg/day every 24 hours whenever > 50% of the calculated volume was given during the previous 24 hours. Multiple regression analysis was used to study the effect of mean GRV and the color of the residual on feeding volume achieved on day 14 (V14).
Results. The median V14 was 103 ml/kg/d (range 0 – 166). There was no significant negative correlation between GRV or green gastric residuals and V14.
Comment. The feeding protocol used in this study seems to be moderately successful (most ELBW infants were tolerating > 100 cc/kg of enteral feedings by 2 weeks of age). The incidence of NEC (Bell stage 2 or greater) was 5%. The finding of no negative correlation between GRV and V14 means that the critical value for gastric residuals (if there is one) must be higher than the 2 or 3 cc used in this protocol. I suspect that too much emphasis is being placed on the volume or color of gastric residuals. A certain amount of gastric dismotility and duodenal-gastral reflux is probably normal in extremely premature infants. It is important to assess these infants clinically for abdominal distension, tenderness, emesis, bloody stools, apnea or bradycardia before making a decision about whether to advance or hold feedings.
Date: 03/20/2002
Re: Gastric residuals
I agree we pay far too much attention to the amount of residual and to abdominal girth.
However, I have to say I get very cautious when the residual is green. I've
been burned with silent perfs and early NEC after greenish residuals.
Richard Auerbach MD
rauerbach@shcr.com
topic: Gastric Residuals
Date: 24 Mar 2002
Time: 00:45:16
Comments:
We have tried to institute an "early trophic feeding" protocol with our
micropreemies, and have been very disappointed. The incidence of significant GI
symptomatology is very high (distension, "pre-NEC" findings on KUB, heme +
stools, etc.) with even minimal feeds, and if they are ignored, severe GI complications
ensue. We give prolonged TPN to all our micro-preemies along with phenobarb, and
start trophic feeds at around 14 days. We don't see NEC with that protocol, and we
seem to see less TPN cholestasis with the phenobarb.
Paul Hinkes, M. D.
Institution: Providence St. Joseph Medical Center, Burbank, CA
telephone: 818-847-3232
email: preemys@msn.com
Date: 17 Jan 2005
Time: 14:36:22
Has anyone read any studies regarding trophic breast milk feedings for babies who are diagnosed with NEC, during the recovery phase of the illness, say after x-rays return to normal and clinical symptoms have resolved?
UserName: Susan Gibson
Institution: University of Washington Med. Center
telephone: 206-598-4606
email:
soozie51@hotmail.com
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