Gastric Residual Volumes in Premature Infants

Briefly noted: B Singh et al. J Pediatr 2018; 200: 79-83.  In this study of 87 infants witth birth weights 1500-2000, avoiding routine assessment of gastric residual volumes before feeding advancement did not shorten the time to reach full feeds.  However, checking these residuals provided no clear advantages and have some potential disadvantages:

  • Time-consuming to check and may inaccurate depending on size/location of orogastric/nasogastric tube
  • Discarding gastric contents results in loss of gastric enzymes and acid

The authors note that prior studies have shown that gastric residuals are “unreliable predictors of feeding intolerance” studies have had discrepancies with regard to whether they are predictive of necrotizing enterocolitis.

Related blog post: When to Check Gastric Residuals in Preterm Infants

When to Check Gastric Residuals in Preterm Infants

A recent study (A Riskin et al. J Pediatr 2017; 189: 128-34) indicates that routine testing of gastric residual volumes is not needed. In this study of preterm infants ≤34 weeks gestation 239 infants were studied prior and 233 studied after dropping routine checks of gastric residuals.

Key findings:

  • Selective evaluation of gastric residuals was associated with achieving full enteral nutrition 1 day earlier
  • The rate of NEC (stage ≥2) was actually lower in the selective evaluation group (1.7% vs 3.3%) compared to the historic control group

Selective checking of gastric residuals was prompted by the following:

  • abdominal distention
  • vomiting or large regurgitation
  • bilious regurgitation or emesis
  • abnormal behaviors: restlessness, somnolence or apathy
  • increased apnea/bradycardia
  • change in vital signs

While checking gastric residuals had been used to determine feeding intolerance and/or development of necrotizing enterocolitis, this study indicates that routine evaluation is not necessary.

My take: This study challenged a common NICU practice and found that routine assessment of gastric residuals is not needed; selective checking of gastric residuals is sufficient.