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Related Experiment Video

Updated: Nov 4, 2025

Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
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Routine prefeed gastric aspiration in preterm infants: a systematic review and meta-analysis.

Jogender Kumar1, Jitendra Meena1, Piyush Mittal1

  • 1Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.

European Journal of Pediatrics
|May 21, 2021
PubMed
Summary

Routine prefeed gastric residue aspiration in preterm infants is common but not supported by evidence. Avoiding this practice is safe and leads to earlier feeding, shorter hospital stays, and reduced late-onset sepsis.

Keywords:
Feed intoleranceGastric aspiratesLow birthweightNecrotizing enterocolitisNutrition

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Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Clinical Nutrition

Background:

  • Routine prefeed gastric residue aspiration is a common practice in preterm infants receiving gavage feeds.
  • Recent evidence suggests this practice may be harmful rather than beneficial.
  • The clinical impact of omitting routine gastric residue aspiration remains unclear.

Purpose of the Study:

  • To evaluate the clinical outcomes of avoiding routine prefeed gastric residue aspiration versus routine aspiration in preterm infants.
  • To assess the safety and efficacy of discontinuing routine gastric residue monitoring.

Main Methods:

  • A systematic review and random-effects meta-analysis of randomized controlled trials.
  • Searched five electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library) up to March 8, 2021.
  • Included 6 studies with 451 preterm infants comparing routine aspiration with no routine aspiration.

Main Results:

  • No significant difference in necrotizing enterocolitis incidence (RR 0.80; 95% CI 0.31 to 2.08).
  • Avoiding routine aspiration was associated with achieving full enteral feeds earlier (MD -3.19 days; 95% CI -4.22 to -2.16).
  • Shorter hospitalization (MD -5.32 days; 95% CI -10.25 to -0.38) and lower late-onset sepsis incidence (RR 0.77; 95% CI 0.60 to 0.99) were observed.

Conclusions:

  • Routine prefeed gastric residue aspiration should be avoided in preterm infants when there are no other signs of feed intolerance.
  • This practice change is associated with improved clinical outcomes, including earlier feeding and reduced sepsis.
  • Low- to moderate-quality evidence supports the safety and benefits of abandoning routine gastric residue monitoring.