The question of when to re-feed gastric residuals (and when to stop feeds on the basis of a large residual) occurs on a daily basis in most large NICUs. The evidence base for the practice is limited but has been reviewed in a recent post from EBNEO Mikael Norman (Professor of Neonatal Medicine at the Karolinska Institute & University Hospital, Sweden) reviewing this recent article in Archives Disease and Childhood (Salas AA, Cuna A, Bhat R, Mcgwin G, Carlo WA, Ambalavanan N. A randomised trial of re-feeding gastric residuals in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2015;100(3):F224-8. PMID 25552280).
You can read the full review here https://ebneo.org/category/reviews/
In summary (and apologies for any paraphrasing) Prof Norman says.... there is no evidence from clinical trials to support either approach (not/re-feeding), especially in the high-risk (for both NEC and undernutrition) group of extremely preterm infants.
Salas et al is to be congratulated .........but for the primary question “Does re-feeding of gastric residual volumes reduce the time needed to achieve full enteral feeding in preterm infants?”, the authors conclude that the answer is no. However, although intention to treat analysis was intended, the primary efficacy end point was only possible to assess in 59 infants, as the estimated sample size (n=72) was not reached. Therefore, there are two possibilities: Either the study may have been under-powered ....... or, the results rightly disprove the hypothesis for an effect size of 2 days difference or more to achieve full feeds.
In addition .... numbers were too small to draw any firm conclusions about safety. Information on the volumes of gastric residuals in the two treatment arms was also lacking...... Finally, donor milk was not offered, possibly contributing to quite high rates reported of intestinal perforation, surgical necrotizing enterocolitis, or death. [Although on this point I'd need to say that the data on whether donor human milk is definitely better when used to supplement mother's own milk is also based on scant evidence]
Norman agrees with the conclusion that re-feeding gastric residual volumes in extremely preterm infants does not seem to reduce time to achieve full enteral feeding, and is likely to be safeBut as always ....further evidence is needed
You can read the full review here https://ebneo.org/category/reviews/
In summary (and apologies for any paraphrasing) Prof Norman says.... there is no evidence from clinical trials to support either approach (not/re-feeding), especially in the high-risk (for both NEC and undernutrition) group of extremely preterm infants.
Salas et al is to be congratulated .........but for the primary question “Does re-feeding of gastric residual volumes reduce the time needed to achieve full enteral feeding in preterm infants?”, the authors conclude that the answer is no. However, although intention to treat analysis was intended, the primary efficacy end point was only possible to assess in 59 infants, as the estimated sample size (n=72) was not reached. Therefore, there are two possibilities: Either the study may have been under-powered ....... or, the results rightly disprove the hypothesis for an effect size of 2 days difference or more to achieve full feeds.
In addition .... numbers were too small to draw any firm conclusions about safety. Information on the volumes of gastric residuals in the two treatment arms was also lacking...... Finally, donor milk was not offered, possibly contributing to quite high rates reported of intestinal perforation, surgical necrotizing enterocolitis, or death. [Although on this point I'd need to say that the data on whether donor human milk is definitely better when used to supplement mother's own milk is also based on scant evidence]
Norman agrees with the conclusion that re-feeding gastric residual volumes in extremely preterm infants does not seem to reduce time to achieve full enteral feeding, and is likely to be safeBut as always ....further evidence is needed
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