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Composition of Coloured Gastric Residuals in Extremely Preterm Infants-A Nested Prospective Observational Study
Gayatri Athalye-Jape1,2, Megan Nettleton1, Ching-Tat Lai3
1Neonatal Directorate, King Edward Memorial Hospital, Perth 6008, Western Australia, Australia.
Insights
Discarding green gastric residuals (GRs) in extremely preterm infants may indicate bile acid loss. Probiotic supplementation in this group reduced time to full feeds and parenteral nutrition duration.
Area of Science:
- Neonatal Nutrition
- Gastroenterology
- Microbiology
Background:
- Green gastric residuals (GRs) in preterm infants are often discarded, potentially indicating feed intolerance.
- Probiotics are investigated for their potential to improve feed tolerance in vulnerable infant populations.
Purpose of the Study:
- To assess the composition and volume of discarded green GRs in extremely preterm (EP) infants.
- To evaluate the impact of probiotic supplementation on feeding outcomes in EP infants.
Main Methods:
- A randomized controlled trial (RCT) analyzed pale and dark green GRs from EP infants (<28 weeks) receiving single or three-strain probiotics.
- Feeding outcomes, including time to full feeds (TFF) and duration of parenteral nutrition (PN), were compared to a placebo group.
Main Results:
- Dark green GRs showed higher, though not statistically significant, bile acid content compared to pale green GRs.
- Mean nutrient loss (fat, nitrogen, carbohydrate) in GRs was minimal.
- Infants receiving probiotics had a shorter median TFF (10 vs. 14 days) and duration of PN (10 vs. 16 days) compared to controls.
Conclusions:
- Discarding dark green GRs in EP infants may signify increased bile acid loss during early enteral feeding.
- Probiotic supplementation in EP infants is associated with improved feeding tolerance, evidenced by reduced TFF and PN duration.
Abstract:
Green gastric residuals (GR) are often considered as a sign of feed intolerance and discarded in preterm infants. Probiotics are known to enhance feed tolerance in preterm infants. To assess the composition (primary outcome) and volume of discarded green GRs, and feeding outcomes in extremely preterm (EP) infants in a probiotic trial, composition of pale and dark green GRs in the first two weeks of life from EP infants (<28 weeks) in a randomized controlled trial (RCT: SiMPro) of single vs. three-strain probiotics was assessed. Feeding outcomes included time to full feeds (TFF: 150 mL/kg/day) and duration of parenteral nutrition (PN). EP infants given placebo in our previous probiotic RCT served as the reference group. Analysis involved linear regression modelling with clustered standard errors for repeated measurements. GRs of 74/103 from 39 SiMPro infants (18: single-strain, 21: three-strain) were analyzed. Bile acid content was higher but statistically insignificant (825.79 vs. 338.1 µmol/L; p = 0.12) in dark vs. pale green GRs. Mean (95% confidence interval) fat, nitrogen, and carbohydrate loss in GRs over the study period was 0.02 g (0.01-0.03), 0.011 g (0.009-0.013), and 0.05 g (0.04-0.06), respectively. Overall, SiMPro infants had shorter median TFF (10 vs. 14 days, p = 0.02) and duration of PN (10 vs. 16 days, p = 0.022) compared with control group infants. Z scores for growth parameters at discharge were comparable. Discarding dark green GRs meant higher loss of bile acids during early enteral nutrition in EP infants. Probiotic supplementation was associated with reduced TFF and duration of PN.
