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Ultrasound assessment of gastric emptying time in preterm infants: A prospective observational study

Christiane E Beck, Lars Witt, Lisa Albrecht

    European Journal of Anaesthesiology
    |April 26, 2019
    PubMed

    Insights

    Preterm infants empty both breast milk and formula milk from their stomachs in under 4 hours. This finding supports shorter pre-anesthesia fasting guidelines for all infant milk types.

    Area of Science:

    • Neonatal medicine
    • Pediatric anesthesiology
    • Gastroenterology

    Background:

    • Shortening pre-operative fasting in pediatric anesthesia is crucial to prevent infant discomfort and metabolic issues.
    • European guidelines suggest 4 hours for breast milk and 6 hours for formula, while some national guidelines permit 4 hours for both.
    • This study addresses the need for evidence-based fasting guidelines for preterm infants.

    Purpose of the Study:

    • To evaluate and compare gastric emptying times in preterm infants after feeding with breast milk versus formula milk.
    • To determine if gastric emptying time is less than the recommended 4-hour fasting period.
    • To provide data supporting optimized pre-anesthesia fasting protocols for neonates.

    Main Methods:

    • A prospective, observational cohort study involving 22 preterm infants (32-40 weeks postmenstrual age).
    • Gastric emptying was assessed using sonographic measurements of the gastric antral area (GAA) at hourly intervals post-feeding (FT0 to FT3).
    • Infants received either breast milk (n=10) or formula milk (n=12) with a mean volume of 50 mL.

    Main Results:

    • Gastric emptying time was significantly correlated with fasting time (r = -0.53, P < 0.0001).
    • The mean calculated gastric emptying time for both breast milk and formula milk was 218 minutes (approximately 3.6 hours).
    • No significant difference in gastric emptying was observed between breast milk and formula milk groups by 3 hours post-feeding.

    Conclusions:

    • The mean gastric emptying time for both breast milk and formula milk in preterm infants is less than 4 hours.
    • These findings support the current national fasting regimen of 4 hours for any milk type in infants prior to anesthesia.
    • Evidence supports shorter, standardized fasting periods for preterm infants undergoing anesthesia, reducing discomfort and potential complications.
    Abstract

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