Association of gastric residual volumes with necrotising enterocolitis in extremely preterm infants-a case-control study.

Gayatri Athalye-Jape,Gajanan Purohit,Puja Mehkarkar,Sanjay Patole,Elizabeth Nathan

doi:10.1007/s00431-021-04193-x

Abstract

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.

Highlights

Necrotising enterocolitis (NEC) is a potentially devastating gastrointestinal emergency predominantly affecting preterm infants, with significant health burden [1,2,3]
GR volume (GRV) was not associated with NEC ≥ stage II
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

Summary

Introduction

Necrotising enterocolitis (NEC) is a potentially devastating gastrointestinal emergency predominantly affecting preterm infants, with significant health burden [1,2,3]. Survivors of surgical NEC are at a high risk for complications such as short bowel syndrome, failure to thrive and neurodevelopmental impairment [4,5,6,7]. The pathogenesis of NEC is poorly understood [1,2,3]. Prematurity is the most single most important risk factor for NEC. Other factors that contribute to its pathogenesis include gut dysbiosis, gestationdependent excessive pro-inflammatory response to toxins such as lipopolysaccharides from intestinal gram-negative organisms, formula feeding and intestinal ischemia [1,2,3]. Preventive strategies include antenatal steroids, exclusive human milk feeding, standardized feeding regimen, prophylactic probiotics and antimicrobial stewardship [8]

Objectives

Results

Discussion

Conclusion