Routine versus no assessment of gastric residual volumes in preterm infants receiving enteral feeding via intermittent feeding tubes: a randomized controlled trial.

OBJECTIVE: To evaluate whether eliminating routine gastric residual volume (GRV) assessments would lead to quicker attainment of full feeding volumes in preterm infants. STUDY DESIGN: This is a prospective randomized controlled trial of infants ≤32 weeks gestation and birthweight ≤1250 g admitted to a tertiary care NICU. Infants were randomized to assess or not assess GRV before enteral tube feedings. The primary outcome was time to attain full enteral feeding volume defined as 120 ml/kg/day. The Wilcoxon rank sum test was used to compare the days to reach full enteral feeds between the two groups. RESULTS: 80 infants were randomized, 39 to the GRV assessing and 41 to the No-GRV assessing group. A predetermined interim analysis at 50% enrollment showed no difference in primary outcome and the study was stopped as recommended by the Data Safety Monitoring Committee. There was no significant difference in median days to reach full enteral feeds between the two groups [GRV assessment: 12d (5) vs. No-GRV assessment:13d (9)]. There was no mortality in either group, one infant in each group developed necrotizing enterocolitis stage 2 or greater. CONCLUSION: Eliminating the practice of gastric residual volume assessment before feeding did not result in shorter time to attain full feeding.

Impact of parenteral nutrition guideline implementation on growth of very low-birth-weight infants in a neonatal intensive care unit.

BACKGROUND: In preterm neonates, parenteral nutrition (PN) is utilized to provide adequate energy and maintain the expected growth rate of a fetus. To optimize growth, our institution implemented comprehensive guidelines for prescribing PN. This study compared the effect of this change on growth outcomes of very low-birth-weight (VLBW) infants at 28 days' postnatal age (PNA). METHODS: Neonates <1250 g who received PN for >7 days were divided into preimplementation and postimplementation cohorts based on date of birth. The primary objective was to compare the average weight velocity (g/kg/day) of neonates at 28 days' PNA. Secondary objectives included identifying the average number of days to regain birth weight and comparing the percentage of infants above the 10th percentile for weight for age at 28 days with those at baseline. RESULTS: There were 204 neonates in cohort 1 (before implementation) and 176 neonates in cohort 2 (after). No difference in weight velocity was identified (12.9 ± 5.2 vs 12.1 ± 4.9 g/kg/day; P = .177). No difference was detected in days to regain birth weight (9.2 ± 4.6 vs 9.9 ± 4.7; P = .909) or in the percentage of patients above the 10th percentile for weight for age (birth: 85.3% vs 83.5% [P = .634]; 28 days: 73% vs 64.8% [P = .082]). CONCLUSION: No difference was observed in the weight velocity of VLBW neonates <1250 g at birth when using the implemented guideline for PN prescription writing at our institution.