We are trying to improve our feeding practices here.

We are searching for consensus for re-feeding residuals; breast milk or formula-

What is your protocol regarding residuals and the extremely pre-term infant?

All views and opinions and data would be considered.

Thank you in advance!

Renee Addy, RNC

UCONN Health Center

Connecticut, USA

dear Rennee,

in our unit, we use brest milk of the natural mamma in the majority of cases. some times where this is impossible to do it, we use a formula for preterm with 10-13% concentration. after initialisation of gastro-duodenal feeding, and after making sure that there is not enteropathy, we try to use a higher concentration: progressively from 13 to 20%. for preterm with brest feeding, we use a solution of eoproteine to concentrate 2-4%.

Hi Rennee! Our policy is to re-feed residuals if they consist of digested breastmilk, and substract the residual volume from the planned feed (keeping the total volume the same).

If residuals looks greenish or otherwise "unfresh" we usually throw it away, and skip the planned feed. Depending on other clinical signs, residuals also later (despite the skipped feed) we handle each case individually. But we are quite scared of NEC in the ELBW infants, and it is not uncommon with a rather careful feeding strategy.

Hi Colleague, as it is known early feeding of ELBW may be a risk factor of NEC. Enteral feeding is begun with 10 ml/kg/d when the infant is medically stable, and if tolarated increase to 10-20 ml/kg/d.Ofcourse breast milk is the best choice for enteral feeding. Be care of residual that looks green,yellow or other color.

We usually re-feed our residuals as long a they are not discolored. If there is any blood or old blood flecks, anything green, or other odd colors, the residual is discarded and a whole new feeding replaces it. It is also important to take into account the clinical picture of the patient when they have these residuals. Is their abdomen distended, have they been stooling, is this the first residual or do they have a history of residuals? Sometimes, depending on the amount of the residual, we return the residual and then feed a whole new feeding on top of it.

Hi all,

In our unit once hemodynamicaly stable and normoxemic we start on intermittent bolus feeds Q3h at 10ml/kg/day and increase by 10-20ml/kg /day.We dont refeed the residuals and are discarded.We check stools for occult blood and monitor abdominal girth also

Dr.V.Lakshmi Neonatologist,Mehta`s Children Hospital,Chennai,India

hi ,

we are re-feeding elbw infants with residuals less than %30 amount of milk or formula . if it is more than % 30 and greenish or yellow in colour we are throwing it away and skip the planned feeding.if residual is clear stomach secretions we are putting back because of decrease hydrochloric acid concentration and hypochloremic alkalosis.