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Omitting routine gastric residual checks may help to accelerate enteral feeds and postnatal growth in stable preterm

Demet Terek1, Mahmut Celik1, Firat Ergin1

  • 1Division of Neonatology, Department of Pediatrics, Ege University Hospital, Bornova, Izmir, Turkey.

JPEN. Journal of Parenteral and Enteral Nutrition
|October 2, 2021
PubMed

Insights

Omitting routine gastric residual checks (GRC) for preterm infants allows for earlier initiation and advancement of minimal enteral feeds (MEFs), leading to improved growth and reduced extrauterine growth restriction.

Area of Science:

  • Neonatal nutrition
  • Pediatric gastroenterology

Background:

  • Gastric residual checks (GRC) are a routine but often misleading precaution for necrotizing enterocolitis (NEC) and intestinal intolerance in preterm infants.
  • Recent trends suggest omitting routine GRCs in neonatal care.

Purpose of the Study:

  • To investigate the impact of omitting routine gastric residual checks (GRC) on necrotizing enterocolitis (NEC), complications, feeding advancement, and growth in preterm infants.
  • To evaluate the effectiveness of a modified nutrition protocol initiating minimal enteral feeds (MEFs) without GRCs.

Main Methods:

  • A retrospective study comparing two groups of preterm infants (≤35 weeks' gestational age).
  • Group 1 (n=60) received care with routine GRCs (2016-2017).
  • Group 2 (n=77) received care without routine GRCs following a protocol change in 2019, starting MEFs and advancing feeds without GRCs.

Main Results:

  • No significant differences in the incidence of NEC or complications were observed between groups.
  • Group 2 (without GRCs) initiated enteral feeds 3 days earlier and reached full feeds 6 days earlier (P < 0.01).
  • Group 2 demonstrated significantly higher weight gain (P < 0.01) and head circumference gain (P < 0.01), with less extrauterine growth restriction.

Conclusions:

  • Early initiation of minimal enteral feeds (MEFs) and omitting routine gastric residual checks (GRC) accelerate enteral feeding advancement in clinically stable preterm infants.
  • This approach positively impacts growth parameters and reduces extrauterine growth restriction.
  • The findings support a shift away from routine GRCs in neonatal nutrition protocols for stable preterm infants.
Abstract

Keywords:
feeding intolerancegastric residualgrowthnecrotizing enterocolitispreterm

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