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PEDIATRICS Vol. 109 No. 3 March 2002, pp. 457-459

The Significance of Gastric Residuals in the Early Enteral Feeding Advancement of Extremely Low Birth Weight Infants

Walter A. Mihatsch, MD*, Patrik von Schoenaich, MD{ddagger}, Hubert Fahnenstich, MD§, Norma Dehne, MD||, Hartmut Ebbecke, MD, Christian Plath, MD#, Hans-Burkhardt von Stockhausen, MD**, Rainer Muche, MS{ddagger}{ddagger}, Axel Franz, MD* and Frank Pohlandt, MD, MS*

* Division of Neonatology and Pediatric Critical Care Medicine, Department of Pediatrics, University of Ulm, Ulm, Germany
{ddagger} KZVA-Kinderklinik, Augsburg, Germany
§ Department of Pediatrics, University of Bonn, Germany
|| Department of Pediatrics, Medical Academy of Dresden, Germany
Department of Pediatrics, University of Münster, Germany
# Department of Pediatrics, University of Rostock, Germany
** Department of Pediatrics, University of Würzburg, Germany
{ddagger}{ddagger} Department of Biometry and Medical Documentation, University of Ulm, Germany

--> Objective. To evaluate whether the mean gastric residual volume (GRV) and green gastric residuals (GR) themselves are significant predictors of feeding intolerance in the early enteral feeding advancement in extremely low birth weight (ELBW; <1000 g) infants.

Design. Ninety-nine ELBW infants were fed following a standardized protocol (day 3–14). At 48 hours of age, milk feeding was started (12 mL/kg/d increments, 12 meals per day). GR were checked before each feeding, and a GRV up to 2 mL/3 mL in infants <=750 g/>750 g was tolerated. In cases of increased GRV, feedings were reduced or withheld. The color of GR was assessed as clear, milky, green-clear, green-cloudy, blood-stained, or hemorrhagic. Multiple regression analysis was used to study the effect of the mean GRV and the color of GR on the feeding volume on day 14 (V14).

Results. The median V14 was 103 mL/kg/d (0–166). V14 increased with an increasing percentage of milky GR, whereas the mean GRV and the color green did not have a significant effect.

Conclusions. 1) Early enteral feeding could be established in ELBW infants. The critical GRV seems to be above 2 mL/3 mL because there was no significant negative correlation between the mean GRV and V14. 2) Green GR were not negatively correlated with V14 and should not slow down the advancement of feeding volumes in absence of other clinical signs and symptoms.

Key Words: infant nutrition • extremely low birth weight infant • gastric residual

Abbreviations: GR, gastric residuals • VLBW, very low birth weight, birth weight less than 1500 g • GRV, gastric residual volume • NEC, necrotizing enterocolitis • ELBW, extremely low birth weight, birth weight less than 1000 g • V14, feeding volume on day 14

Received for publication Apr 16, 2001; Accepted Aug 23, 2001.


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Relationship Of Gasric Residuals Volume In Extremely Premature Infants And Early feeding
Sunil Jain
Pediatrics Online, 1 Apr 2002 [Full text]
In Reply.-
Walter A Mihatsch, et al.
Pediatrics Online, 5 Jun 2002 [Full text]