Location: Children's Nutrition Research CenterTitle: Evaluation of potential factors predicting attainment of full gavage feedings in preterm infants Author
Submitted to: Neonatology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/9/2010
Publication Date: 6/30/2010
Citation: Shulman, R.J., Ou, C., Smith, E.O. 2010. Evaluation of potential factors predicting attainment of full gavage feedings in preterm infants. Neonatology. 99:38-44. Interpretive Summary: Infants born preterm have great difficulty tolerating feedings. Until they can tolerate all feedings through their gastrointestinal tract, they must be given nutrition through their veins. It is not clear what measures can be used to predict when preterm infants will tolerate feedings. In this study, common measures used to assess whether preterm infants tolerate feedings, were evaluated to determine if they actually were helpful in knowing when an infant would tolerate all feedings through the gastrointestinal tract. In addition, newer tests also were evaluated. It was found that the amount of enzyme activity responsible for the digestion of the sugar in human milk and formula was the best predictor of when preterm infants would be able to receive all their nutrition through the gastrointestinal tract. Commonly used tests and the other newer tests were not helpful.
Technical Abstract: The clinical measures of gastric residuals and abdominal distention are often used to guide feeding in preterm infants, but there are few data demonstrating their usefulness. Similarly, techniques are now available to investigate gastrointestinal (GI) function noninvasively and safely, but their ability to predict attainment of full gavage feedings and/or feeding volume in preterm infants is unclear. We sought to determine prospectively the potential relationships of attainment of full gavage feedings and feeding volume with clinical measures and noninvasive GI tests. Fifty preterm infants were followed prospectively. Daily tally was taken of gavage feeding intake, gastric residual volumes (GRVs); and abdominal distention. Infants underwent repeated measurement of lactase activity, GI permeability, fecal calprotectin concentration, and gastric emptying. The number of GRVs >2 ml/kg tended to decrease with postnatal age. Lactase activity and feeding volume in milliliters per kilogram per day prior to achieving full feedings were correlated. There was no correlation between feeding outcomes and GRV, GRV >50%, GRV >2 ml/kg, small bowel, colonic, or whole bowel permeability, fecal calprotectin concentration, gastric emptying, or abdominal distention. We conclude that GRV is unreliable in predicting attainment of full gavage feeding. Lactase activity is related to feeding volume. However, other noninvasive GI tests utilized were not predictive. These data cast doubt upon the utility of GRV in guiding feeding therapy. Randomized trials of different GRV management protocols are needed.