Preemies' nutritional outcomes better without gastric-residual evaluation

Last Updated: 2019-05-02

By Anne Harding

NEW YORK (Reuters Health) - Skipping gastric-residual evaluation in extremely preterm infants improves nutritional outcomes and shortens their stay at the neonatal intensive-care unit (NICU), a new randomized clinical trial shows.

Infants who did not undergo gastric-residual evaluation advanced faster on their feedings and went home from the hospital eight days earlier, on average, than those who were evaluated before feedings, Dr. Leslie A. Parker of the University of Florida, Gainesville and colleagues report in JAMA Pediatrics, online April 29.

"One of the ways we have traditionally sought to see whether these babies are tolerating their feeds is to take a syringe and hook it to the end of the feeding tube and pull everything out of the stomach," Dr. Parker told Reuters Health by phone. "These decisions were really made based on not much, they were kind of random decisions."

Evaluation of gastric residuals for patients on feeding tubes has been the standard of care for decades, she added, with little evidence of any benefit. More recently, small studies have suggested that patients do better without it.

To investigate, Dr. Parker and her colleagues randomly assigned 143 infants to prefeed gastric-residual evaluation (74) or no evaluation (69) for six weeks.

The group that did not have gastric-residual evaluation increased their feeds significantly more quickly (20.7 mg/kg/day vs. 17.9 mg/kg/day), and had more feedings at week 5 and week 6, compared to those who did have the procedure.

Mean estimated log weights also were significantly higher in the no-evaluation group, and abdominal distention occurred less frequently (0.59 vs. 1.79, P=0.001).

The infants who didn't undergo prefeed evaluation also went home from the hospital earlier than those who had the procedure (4.21 vs. 4.28, P=0.01).

Risk of necrotizing enterocolitis, death, late-onset sepsis and ventilator-associated pneumonia were similar for the two groups.

Feedings may be decreased or even stopped in NICU patients found to have large gastric-residual volume, Dr. Parker noted. "Enteral nutrition . . . is very important for the growth and development of these infants, so if you decrease or stop it they can have some problems," she said.

Gastric-residual evaluation should be used in children who show other signs of feeding intolerance, she added, but it is no longer a routine part of care on her unit. "It's good for everyone, but especially the babies and their families," she said.

SOURCE: https://bit.ly/2LlzH8q

JAMA Pediatr 2019.