Abstract
Problem: Preterm infants have an increased susceptibility to feeding intolerance and increased gastric residuals. With an unknown correlation between feeding intolerance and development of necrotizing enterocolitis (NEC), emphasis needs to be placed on determining the role of gastric residuals in hopes of decreasing the adverse outcomes of decreased weight gain and neurodevelopmental complications. Without clinical guidelines or standards in place, these infants may be potentially affected by unnecessary delays in feeding advancement, extended hospital stays, and increased expenses. The providers’ order regarding the gastric residuals may lead to feeding volume and caloric deficiencies.|Methods: This prospective, exploratory, pilot study included infants weighing less than 1800 grams admitted to Sanford Health Fargo Region NICU and Essentia Health Fargo Region NICU. The bedside nurse recorded the infant’s birth weight, amount of feedings received, amount of pre-feed gastric residual obtained, signs of abdominal distension, emesis, or intolerance noted, and how the provider responded to the residual (refed, discarded, or NPO) on a daily survey at the patients’ bedside.|Results: Data were collected on 17 infants with a total of 1059 feedings. The number of days infants were observed varied from 2 to 47. Residuals were not present in 56% of the feedings recorded. Of the 469 decisions that were made on residuals, 70% were refed the residual and given an additional full feeding, 20% of residuals were refed and subtracted from the subsequent feeding, 6% of residuals were discarded with full subsequent feeding, 3% of residuals were refed with no additional feeding given, and 1% of residuals were discarded with feeding held or the infant was made NPO. Therefore, 30% of the feedings resulted in a decrease in fluid volume and nutritional calories.|Conclusions: The routine use of gastric residuals to assess feeding tolerance is common practice in the NICU. There are some units where measuring gastric residuals are not done. In units without routine gastric residual evaluation, the infants reached full feedings sooner and have fewer days of venous access. Providers continue to make decisions based on gastric residuals that are not evidence-based. The data collected illustrated the vast variety of ways providers manage gastric residual volumes. Residuals were refed, discarded, or subtracted even when there were no other symptoms of feeding intolerance. This information supports the need for further research regarding gastric residuals and how to best manage the information we obtain when checking a residual.