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Enteral feeding algorithm of preterm infants, which is used in our neonatal intensive care unit. CRP, C-reactive protein.
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Aspiration and evaluation of gastric residuals are commonly performed interventions before each feeding in intensive care units, especially in very low birthweight infants. However, there is no sufficient evidence about the necessity of routine gastric residual aspiration. In this study, we aimed to investigate the time to full enteral intake and t...
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Abstract Introduction About 30% of patients with Guillain-Barré syndrome become ventilator dependent, of whom roughly 75% develop pneumonia. This trial aimed at assessing the impact of early mechanical ventilation (EMV) on pneumonia occurrence in GBS patients. We hypothesize that EMV will reduce the incidence of pneumonia. Methods This was a single...
Citations
... NEC is a life-threatening gastrointestinal emergency that disproportionately affects preterm infants, with potentially devastating consequences [15,24]. The condition is characterized by inflammation and necrosis of the intestinal tissue, leading to high rates of morbidity and mortality [25][26][27]. ...
... The validity and reliability of medical records as a data source have been well-established in previous studies [15,24]. Data was extracted by trained nurses using an extraction manual to ensure standardized collection. ...
The practice of routine gastric residual aspiration in preterm infants remains controversial, with conflicting evidence regarding its impact on necrotizing enterocolitis (NEC). As front-line caregivers, nurses play a vital role in gastric aspiration procedures and must be informed by evidence. This quasi-experimental nursing study aimed to assess whether gastric aspiration is clinically relevant in reducing the risk of NEC in preterm infants.
A total of 250 preterm infants from two NICUs in Egypt were allocated to the gastric aspiration (n = 125) and non-aspiration (n = 125) groups. Feeding practices, gastric residuals, and incidence/severity of NEC were compared between groups according to modified Bell’s criteria. Risk factors were analyzed using multivariate regression. There were no significant baseline differences between the groups. The gastric residual attributes and feeding outcomes did not differ substantially from aspiration. The overall incidence of NEC was 14–15%, with no significant differences in the odds of onset or progression of NEC by stage between the groups. Lower gestational age and birth weight emerged as stronger predictors of NEC. Routine gastric aspiration does not appear to directly prevent or reduce the severity of NEC in this population. Although gastric residuals retain clinical importance, study findings question assumptions that aspiration protects against NEC and informs nursing practice. Evidence-based feeding protocols must continually evolve through ongoing research on modifiable risk factors for this devastating intestinal disease in preterm infants.
... In addition, there was no significant difference between the control and study groups regarding the content of gastric residual, Ryle insertion, and parenteral nutrition at a p-value >0.05. These results cohort with the study (Akar & Turgut, 2020) about Whether we control gastric residuals unnecessarily in premature newborns? AGRA studied: avoidance of residual gastric aspiration and stated that days of parenteral nutrition in group one was 3.56±6.0 ...
... Researchers (Akar & Turgut, 2020) investigated whether it is necessary to control gastric residuals in premature newborns and found that the answer was yes. ...
... Regarding the study's outcomes, the results showed a clear difference between the two groups in terms of exposure to gastrointestinal necrosis, incubator infection, and the child's weight upon discharge from the hospital. These results cohort with the study (Akar & Turgut, 2020) about Whether we control gastric residuals unnecessarily in premature newborns? AGRA studied: avoidance of residual gastric aspiration and stated that the group without routine residual control had a shorter time to full enteral intake (p 0.05). ...
Background: Gastric residuals (GR) aspiration is considered standard practice for preterm infants in the neonatal intensive care unit (NICU). Unfortunately, there is little information about the dangers and advantages of this routine procedure. Various care procedures, such as the measurement of gastric residual volume (GRV), may contribute to the problem of inadequate calorie intake in preterm newborns. Aim: The current study aimed to evaluate the effect of non-gastric residual aspiration on preterm infant weight, necrotizing enterocolitis, and time to reach full enteral feeding. Methods: A quasi-experimental (control and intervention) design was used in the study. El-Manial University Hospital and Elmonira Pediatric Hospital NICUS cared for sixty preterm infants. Four different tools were used: (I) Neonatal personal information; (II) a gastric residual observational checklist; (III) the Fenton Growth Weight Chart; and (IV) Modified Bell's Staging Criteria for Necrotizing Enterocolitis. The results: The mean number of days required to achieve full enteral intake of 120 ml kg per day in the intervention group was 7.21 ± 0.66, whereas, in the control group, it was 9.72 ± 0.85, a difference that was slightly significant at the p-value < 0.05.
... The intervention group took less time than the control group. Researchers [12] investigated whether it is necessary to control gastric residuals in premature newborns and found that the answer was yes. There was no signi cant difference in the number of days of parenteral nutrition between groups one and two, with a p-value of 0.91, when AGRA examined the avoidance of residual gastric aspiration. ...
... Regarding the study's outcomes, the results in table (4) showed a clear difference between the two groups in terms of exposure to gastrointestinal necrosis, incubator infection, and the weight of the child upon discharge from the hospital. These results cohort with the study [12] about Whether we control gastric residuals unnecessarily in premature newborns? AGRA studied: avoidance of residual gastric aspiration and stated that the group without routine residual control had a shorter time to full enteral intake (p 0.05). ...
Purpose: The current study aimed to evaluate the effect of non-gastric residual aspiration on preterm infant health status
Methods: The study utilized a quasi-experimental (control and intervention) design. Sixty premature infants were cared for at El Manial University Hospital and Elmonira Pediatric Hospital NICUS. Four tools were utilized: (I) Neonatal personal data; (II) gastric residual observational checklist; (III) the Fenton Growth Weight Chart; and (IV) Modified Bell's Staging Criteria for Necrotizing Enterocolitis
Results: The mean gastric amount in the intervention group was 1.45 ± 0.35, while the control group was 2.53 ± 0.49, with a p-value <0.05. The mean days to full enteral intake of 120 ml kg per day of the intervention group was 7.21±0.66, while the control group was 9.72±0.85, with a slightly significant difference at p-value <0.05. The minority of the intervention group suffered from sepsis, while about one-quarter at the control group. According to NEC, the minority of the intervention group suffered definite.
Conclusion: Eliminating routine prefeed gastric aspirate monitoring decreases late-onset sepsis, permits preterm infants to receive complete enteral feeds sooner, and allows them to leave the hospital sooner. It also did not affect the likelihood of mortality or NEC.
... Akar and Turgut [25] recently assessed the impact of avoiding routine monitoring of GRV on TFF and incidence of NEC in preterm (GA ≤ 33 weeks) infants [25]. Their observational study compared infants in the historical (Epoch 1 169, routine GRV monitoring) vs. prospective cohort (Epoch 2: n = 122, no routine GRV monitoring). ...
... Akar and Turgut [25] recently assessed the impact of avoiding routine monitoring of GRV on TFF and incidence of NEC in preterm (GA ≤ 33 weeks) infants [25]. Their observational study compared infants in the historical (Epoch 1 169, routine GRV monitoring) vs. prospective cohort (Epoch 2: n = 122, no routine GRV monitoring). ...
... The TFF was significantly shorter in epoch 2 (p < 0.05), but NEC ≥ stage II, duration of parenteral nutrition and hospital stay and weight at discharge were comparable. Duration of invasive mechanical ventilator support was shorter in epoch 2 [25]. ...
Necrotising enterocolitis (NEC) is a potentially serious illness with significant mortality and morbidity in preterm infants. Previous studies have reported association of volume and colour (bile and blood stained) of gastric residuals (GR) with NEC. We aimed to study this association in our cohort of extremely preterm (EP) infants. In a case–control study using retrospective data (January 2006–December 2011), EP (gestation < 28 weeks) infants with confirmed NEC ≥ stage II (cases) were compared with infants without NEC (controls) matched for birth weight (BW) and gestational age (GA). Forty cases of NEC ≥ stage II diagnosed at a median (IQR) age of 16.5 days (10.3–23) were compared with 40 controls matched for gestation (± 3 days) and birth weight (± 680 g). Median maximum GR volume (GRV) from birth to the day of occurrence of NEC was significantly higher in cases vs. controls (5.9 vs.3.7 ml; p < 0.001). Increased maximum GRV was associated with NEC ≥ Stage II in adjusted analysis (aOR 1.36, 95%CI 1.06–1.75, p = 0.017). There was no significant difference in GRV between cases and controls throughout the clinical course, including 72, 48 and 24 h before the onset of NEC. However, green (65.0% vs. 27.5%, p = 0.001) and haemorrhagic GRs (45.0% vs. 27.5%, p = 0.092) were higher 24 h before the diagnosis of NEC.Conclusion: GRV was not associated with NEC ≥ stage II. However, green and haemorrhagic GRs were significantly higher 24 h before the diagnosis of the illness. Adequately powered prospective studies are needed to confirm the significance of our findings.
What is Known:
•It is unclear whether large volume, dark-coloured and blood-stained GRs are associated with NEC.
•The value of routine monitoring of gastric residuals in preterm infants is currently being questioned.
What is New:
•Volume of gastric residuals was not associated with significant NEC.
•Green and haemorrhagic GRs were significantly higher 24 hours before diagnosis of NEC.
... Eligibility: All preterm ELBW infants born <28 weeks of gestation and admitted to the NICU between January 2006 -December 2011 were eligible considering they are at higher risk of NEC [23][24][25][26][27][28][29][30][31] Exclusion: Out-born infants, those with congenital gastrointestinal malformations or chromosomal abnormalities. ...
... Akar et al (2020) recently assessed the impact of avoiding routine monitoring of GRV on TFF and incidence of NEC in preterm (GA ≤ 33 weeks) infants [24]. Their observational study compared infants in the historical (Epoch 1: 169, The limitations of our study include the case control design and small numbers. ...
Necrotising enterocolitis (NEC) is a potentially serious illness with significant mortality and morbidity in preterm infants. Previous studies have reported association of volume and colour (bile and blood stained) of gastric residuals (GR) with NEC. We aimed to study this association in our cohort of extremely preterm (EP) infants. In a case-control study using retrospective data (January 2006-December 2011), EP (Gestation <28 weeks) infants with confirmed NEC ≥ Stage II (Cases) were compared with infants without NEC (Controls) matched for birth weight (BW) and gestational age (GA). Forty cases of NEC ≥ Stage II diagnosed at a median (IQR) age of 16.5 (10.3-23) days were compared with 40 controls matched for gestation (±3 days), and birth weight (±680 g). Median maximum GR volume (GRV) from birth to the day of occurrence of NEC was significantly higher in cases vs. controls (5.9 vs.3.7 ml; p<0.001). Increased maximum GRV was associated with NEC ≥ Stage II in adjusted analysis (aOR 1.36, 95%CI 1.06-1.75, p=0.017). There was no significant difference in GRV between cases and controls throughout the clinical course, including 72, 48 and 24 hours before the onset of NEC. However, green (65.0% vs. 27.5%, p=0.001) and haemorrhagic GRs (45.0% vs. 27.5%, p=0.092) were higher 24 hours before the diagnosis of NEC.
Conclusion: GRV was not associated with NEC ≥ Stage II. However, green and haemorrhagic GRs were significantly higher 24 hours before the diagnosis of the illness. Adequately powered prospective studies are needed to confirm the significance of our findings.
... Historically, measurement of gastric residual volume prior to a feeding is done to assess gastric emptying, measure tolerance of enteral tube feedings, and reduce aspiration risk; however, more research is needed to understand the significance of this measurement and how often measurement should occur. [3][4][5][6] The practice of aspirating prior to a feed is routine in many intensive care units, yet there is little evidence to support it and a lack of a uniform standard to guide practice. Protocols and practice vary not only across the United States but throughout the world. ...
... 7,8 Routine monitoring of gastric residuals delays acquisition of full feeds in patients in the neonatal intensive care unit (NICU) and achievement of energy targets in patients in the pediatric intensive care unit. 2,6,9,10 This practice should not be used as a standalone tool for evaluating feeding tolerance but instead should be combined with data such as nausea, vomiting, abdominal distention, abdominal tenderness or discoloration, bloody stool, sepsis, and the use of sedation or vasopressors. 2,6,11 Gastric residual volume measurement has not been shown to be a reliable indicator of gastric emptying in critically ill children. ...
... 2,6,9,10 This practice should not be used as a standalone tool for evaluating feeding tolerance but instead should be combined with data such as nausea, vomiting, abdominal distention, abdominal tenderness or discoloration, bloody stool, sepsis, and the use of sedation or vasopressors. 2,6,11 Gastric residual volume measurement has not been shown to be a reliable indicator of gastric emptying in critically ill children. 7,10, 12 We cannot assume a lack of aspirate equals gastric emptying. ...
