Gastric Residual

[gmustafa]

For babies, less than 1.5 kg, how often nurses in you NICU check for gastric residual? And if there is some gastric residual, then do nurses discard it OR push it back and give additional feeding? How you make decision to advance feeding based on amount of gastric residual, provided patient is otherwise doing well? Are these decisions based on evidence or personal preferences?

[Stefan Johansson]

This is a hot topic!

From the later trials and systematic reviews, it seems that routine checks does not add anything.

We check the position of the tube my aspirating, but do not check residuals as such unless there is symtoms suggesting abdominal disease. We rarely discard residuals (only if blood/bile and we plan fasting anyway due to NEC scare)

Looking fw to hear others practises - I believe this is an every-day thing with many different approaches  

Check these references out:

• Singh 2018: https://www.jpeds.com/article/S0022-3476(18)30626-7/fulltext
• Parker 2019: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2732145
• Cochrane 2019: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012940.pub2/full
• Cochrane 2019: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012937.pub2/full

 

[bimalc]

The data is fairly clear that routine checking of gastric residuals is neither sensitive nor specific for serious pathology (aside from possibly enteric tube placement).  The practice is associated prolonged time to full enteral feeds which itself is associated with a number of downstream consequences (increased central line days, extrauterine growth failure, LOS, etc.).  While the Cochrane reviews indicate these secondary effects are uncertain, the preponderance of evidence favors either no difference or favors not checking.