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ARTICLE: Walter A. Mihatsch, Patrik von Schoenaich, Hubert Fahnenstich, Norma Dehne, Hartmut Ebbecke, Christian Plath, Hans-Burkhardt von Stockhausen, Rainer Muche, Axel Franz, and Frank Pohlandt The Significance of Gastric Residuals in the Early Enteral Feeding Advancement of Extremely Low Birth Weight Infants Pediatrics 2002; 109: 457-459 [Abstract] [Full text] [PDF]

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Relationship Of Gasric Residuals Volume In Extremely Premature Infants And Early feeding

Sunil Jain   (1 April 2002)

In Reply.-

Walter A Mihatsch, Frank Pohlandt   (5 June 2002)

Relationship Of Gasric Residuals Volume In Extremely Premature Infants And Early feeding 1 April 2002
Sunil Jain, Physician St. John's Hospital, Springfield IL 62769 Send letter to journal: Re: Relationship Of Gasric Residuals Volume In Extremely Premature Infants And Early feeding jainsunil{at}hotmail.com Sunil Jain	We read your study with great intrest and actually discussed it in our weekly departmental journal club meeting. Clinical significance of amount of gastric residual volume (GRV) and its colour in extremely premature infants is a day to day question raised by the bed side nurses with no one correct answer. As far as GRV is concerned, I think it will be better if one considers the percentage of prior feed rather than a number like 2mL or 3mL. The common cause of greenish gastric aspirates (GA) in healthy infants is misplaced nasogastric tubes. In your study also, greenish aspirates did not corelates with any adverse outcome. I think, getting abdominal X-ray may resolve the issue of misplaced nasogastric tube. How did abdominal gentle massage help? In our NICU, we try to avoid such manupulations to avoid feeding intolerence.
In Reply.- 5 June 2002
Walter A Mihatsch, Physician Universitäts-Kinderklinik, 89070 Ulm, Germany, Frank Pohlandt Send letter to journal: Re: In Reply.- walter.mihatsch{at}medizin.uni-ulm.de Walter A Mihatsch, et al.	Please format the table We thank Dr. Jain for his letter. His first question addresses the question whether the gastric residual volume (GRV) should be better related to the prior feed. This would require the definition of acceptable GRVs for a wide spectrum of feeding volumes (vol.), because the percentage of prior feed decreased from 81% (day 3) to 8% (day 13) (Table). Day of life 3 4 5 6 7 8 9 10 11 12 13 14 Median feeding vol. (ml/kg/day), 12 feeds/day 11 22 32 43 53 60 68 81 92 101 112 114 Average vol. of a single feed (ml) 0.9 1.8 2.7 3.6 4.4 5.0 5.7 6.8 7.7 8.4 9.3 9.5 Average GRV 0.74 0.80 0.82 0.80 0.81 0.79 0.82 0.77 0.77 0.76 0.79 0.77 Average GRV as percentage of the average vol. of a single feed 81% 44% 31% 22% 18% 16% 14% 11% 10% 9% 8% 8% 2. In our experience misplaced nasogastric tubes are only one minor reason for greenish gastric aspirates (GGA) in early enteral feeding advancement in healthy ELBW infants. However, GGA are a frequent event. Since the color green itself did not prove to be of significant importance in absence of other sings and symptoms, what is the benefit of all this extra X-rays? 3. With regard to preprandial gentle abdominal massage, for study reasons we tried to measure the GRV as exactly as possible. We agree, postprandial abdominal manipulation can induce reflux. However, the effect of preprandial abdominal massage itself has never been studied in ELBW infants.