Gastric Volume Changes in Preterm Neonates during Intermittent and Continuous Feeding-GRV and Feeding Mode in Preterm Neonates.

Rozeta Sokou,Ioanna N Grivea,Maria Baltogianni,George Antonogeorgos,Aikaterini Konstantinidi,Fedra Kokori,Eleni Gounari,Polytimi Panagiotounakou,Antonios K Gounaris

doi:10.3390/children8040300

Abstract

Background: We aimed to evaluate gastric volume changes during intermittent milk feeds (IMF) and continuous milk feeds (CMF) in very premature neonates (VPN), with gastric residual volume (GRV) based on antral cross-sectional area (ACSA) measurements and to examine if there were differences in GRV between the two feeding methods. Methods: A randomized prospective clinical trial with crossover design was conducted in 31 preterm neonates (gestational age < 30 weeks). Gastric volume was assessed twice in each neonate (during IMF and CMF feeding), at 7 specific time points during a 2-h observation period by measuring ACSA changes via the ultrasound (U/S) method. Results: There was a significantly different pattern of gastric volume changes between the two feeding methods. GRV, expressed as the median percentage of ACSA measurement at 120 min relative to the higher ACSA measurement during IMF, was found to be 3% (range 0–25%) for IMF and 50% (range 15–80%) for CMF. Neonates fed with IMF had a shorter mean gastric emptying time compared to those fed with CMF (p = 0.0032). No signs of feeding intolerance were recorded in either group during the period of observation. Conclusions: Our results showed that gastric volume changes and gastric emptying time in VPN, based on ACSA measurement changes, depend on the milk feeding method. No gastrointestinal complications/adverse events were noted with GRV up to 80% with CMF.

Highlights

Feeding intolerance, defined as the inefficiency of the gastrointestinal system of very preterm neonates (VPN) to digest milk, is associated with the presence of increased prefeed gastric residual volumes (GRVs) and expressed with vomiting/abdominal distention/desaturations/bradycardia/apnea, often leading to the disruption of a feeding plan in this fragile population.During the first weeks of life, very low birth weight (VLBW) and especially extremely low birth weight (ELBW) neonates, commonly exhibit feeding intolerance and a delay in gastric emptying [1,2,3]
No infant displayed signs of feeding intolerance such as vomiting, apnea, bile/blood stained aspirate, visible bowel loops, abdominal distension and no infant developed necrotizing enterocolitis (NEC). This single-center, randomized, prospective crossover clinical trial showed that in very preterm neonates, the milk feeding method had an influence on gastric volume changes as well as on gastric emptying time, based on antral cross-sectional area (ACSA) measurement changes
One meta-analysis concluded that developing universal recommendations regarding the best feeding method for infants less than 1500 gr is problematic [7] and more recently Wang et al [16] reported that intermittent feeding may be more beneficial for low birth weight neonates, but welldesigned and evidenced-based studies are required to determine the most appropriate feeding method for preterm neonates

Summary

Introduction

Feeding intolerance, defined as the inefficiency of the gastrointestinal system of very preterm neonates (VPN) to digest milk, is associated with the presence of increased prefeed gastric residual volumes (GRVs) and expressed with vomiting/abdominal distention/desaturations/bradycardia/apnea, often leading to the disruption of a feeding plan in this fragile population.During the first weeks of life, very low birth weight (VLBW) and especially extremely low birth weight (ELBW) neonates, commonly exhibit feeding intolerance and a delay in gastric emptying [1,2,3]. We aimed to evaluate gastric volume changes during intermittent milk feeds (IMF) and continuous milk feeds (CMF) in very premature neonates (VPN), with gastric residual volume (GRV) based on antral cross-sectional area (ACSA) measurements and to examine if there were differences in GRV between the two feeding methods. Gastric volume was assessed twice in each neonate (during IMF and CMF feeding), at 7 specific time points during a 2-h observation period by measuring ACSA changes via the ultrasound (U/S) method. Conclusions: Our results showed that gastric volume changes and gastric emptying time in VPN, based on ACSA measurement changes, depend on the milk feeding method. No gastrointestinal complications/adverse events were noted with GRV up to 80% with CMF

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