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Gastric residuals in preterm babies
A K Malhotra1, A K Deorari, V K Paul
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Insights
Gastric residual (GR) volume in preterm infants significantly decreased over time. Prone positioning and a 2cm abdominal girth increase can indicate a need to adjust oral feeds.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Infant Nutrition
Background:
- Gastric residual (GR) volume is a key indicator of feeding tolerance in preterm infants.
- Understanding factors influencing GR is crucial for optimizing infant nutrition and growth.
- Preterm infants exhibit diverse feeding needs and potential complications.
Purpose of the Study:
- To evaluate gastric residual (GR) volumes in healthy preterm infants.
- To assess the impact of feeding position (supine vs. prone) on GR.
- To determine the relationship between abdominal girth changes and GR in neonates.
Main Methods:
- Gastric residual (GR) volume was measured in 50 healthy preterm infants (gestational age 28-36 weeks).
- Infants were categorized as appropriate-for-dates (AFD) or small-for-dates (SFD).
- GR was assessed in supine and prone positions, with expressed breastmilk (EBM) and formula.
Main Results:
- A significant decrease in GR volume was observed from day 4 (20.7%) to day 7 (8.6%) (P < 0.001).
- Prone positioning reduced GR volume compared to the supine position (12.8% vs. 24.4% with EBM, P < 0.01).
- An abdominal girth increase of ≥2 cm correlated with GR volumes of ≥23%, suggesting a potential feeding intolerance warning.
Conclusions:
- Gastric residual volumes in preterm infants decrease significantly within the first week of enteral feeding.
- Prone positioning appears to improve gastric emptying and reduce GR.
- Monitoring abdominal girth along with GR provides valuable insights for adjusting feeding regimens in preterm infants.
Abstract:
The gastric residual (GR) volume was measured in 50 healthy preterm babies, 38 appropriate-for-dates (AFD), and 12 small-for-dates (SFD) with gestational age of 28-36 weeks. The mean basal 4-hour gastric residual (B4 GR) volume was 2.8 +/- 0.63 ml in parenterally fed babies. There was a marked decrease in the residuals from 20.7 +/- 15.2 per cent (mean +/- SD) on day 4 to 8.6 +/- 4.3 per cent on day 7 (P < 0.001). Of the 27 infants fed with expressed breastmilk (EBM), mean GR was 24.4 +/- 10.2 per cent in supine and 12.8 +/- 4.3 per cent in prone position (P < 0.01). Twenty-one babies nursed in the prone position showed a mean GR volume of 12.8 +/- 4.3 per cent with EBM and 13.6 +/- 2.7 per cent with milk formula. No difference was noted in the gastric residuals of AFD v. SFD babies. No linear correlation was found between increase in abdominal girth and GR. However, if the increase in abdominal girth was at least 2 cm or more, a GR of 23 per cent or more was observed. This should be taken as warnings to reduce or withhold oral feeds.
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