Influence of gastric residual assessment in preterm neonates on time to achieve enteral feeding (the GRASS trial) —Multi-centre, assessor-blinded randomised clinical trial

Conclusion:  There was no difference in time to attainment of enteral feeds of 100 ml/kg/day in premature infants when gastric residuals were not monitored. In the absence of a clinical benefit to routine monitoring, it may be appropriate to discontinue this practice and only monitor residuals when clinical c oncern of feeding intolerance or gastrointestinal pathology arises in this group of patients.Trial registration:  NCT03111329—https://clinicaltrials.gov/. Registered 06/04/2017.What is Known:• Previous randomized trials have shown little benefit to the performance of routine assessment of gastric residuals in preterm infants. Despite this, they continue to be performed due to concerns from observational data regarding development of NEC. Meta-analysis to date has failed to answer the question regarding NEC.What is New:• In very low birth weight infants who are fed using modern feeding practice of faster feed advancement, to minimize use of central access and parenteral nutrition, exclusion of routine checks of gastric residuals did not increase the proportion of infants reaching full enteral feeds by day 5. No harm was seen when residual checks were not performed.• In the absence of a clinical benefit to the routine performance of gastric residuals in very low birth weight infants, it may be appropriate to discontinue their use and instead check residuals when clinical concern of pathology arises.
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research