Thomas Shemi, Nesargi Saudamini, Roshan Preena, Raju Renjita, Mathew Shiny, P Sheeja, Rao Suman
Department of Paediatrics, St John's College of Nursing (Mrs Thomas, Drs Mathew and Sheeja, Ms Raju and Mrs Roshan) Bangalore, Karnataka, India; and Department of Neonatology, St John's Medical College Hospital, Bangalore, Karnataka, India (Dr Nesargi and Dr Rao).
Adv Neonatal Care. 2018 Aug;18(4):E13-E19. doi: 10.1097/ANC.0000000000000532.
Preterm neonates often have feed intolerance that needs to be differentiated from necrotizing enterocolitis. Gastric residual volumes (GRV) are used to assess feed tolerance but with little scientific basis.
To compare prefeed aspiration for GRV and prefeed measurement of abdominal girth (AG) in the time taken to reach full feeds in preterm infants.
This was a randomized controlled trial. Infants with a gestational age of 27 to 37 weeks and birth weight of 750 to 2000 g, who required gavage feeds for at least 48 hours, were included. Infants were randomized into 2 groups: infants in the AG group had only prefeed AG measured. Those in the GRV group had prefeed gastric aspiration obtained for the assessment of GRV. The primary outcome was time to reach full enteral feeds at 150 mL/kg/d, tolerated for at least 24 hours. Secondary outcomes were duration of hospital stay, need for parenteral nutrition, episodes of feed intolerance, number of feeds withheld, and sepsis.
Infants in the AG group reached full feeds earlier than infants in the GRV group (6 vs 9.5 days; P = .04). No significant differences were found between the 2 groups with regard to secondary outcomes.
Our research suggests that measurement of AG without assessment of GRV enables preterm neonates to reach full feeds faster than checking for GRV.
Abdominal girth measurement as a marker for feed tolerance needs to be studied in infants less than 750 g and less than 26 weeks of gestation.
早产儿常出现喂养不耐受，需要与坏死性小肠结肠炎相鉴别。胃残余量（GRV）用于评估喂养耐受性，但缺乏科学依据。
比较早产儿达到完全喂养所需时间内，GRV的餐前抽吸与餐前腹围（AG）测量。
这是一项随机对照试验。纳入孕周为27至37周、出生体重为750至2000g且需要管饲喂养至少48小时的婴儿。婴儿被随机分为两组：AG组婴儿仅测量餐前AG。GRV组婴儿进行餐前胃抽吸以评估GRV。主要结局是达到150mL/kg/d的完全肠内喂养且耐受至少24小时的时间。次要结局包括住院时间、肠外营养需求、喂养不耐受发作次数、喂养中断次数和败血症。
AG组婴儿比GRV组婴儿更早达到完全喂养（6天对9.5天；P = 0.04）。两组在次要结局方面未发现显著差异。
我们的研究表明，不评估GRV而测量AG能使早产儿比检查GRV更快达到完全喂养。
腹围测量作为喂养耐受性标志物，需要在体重小于750g、孕周小于26周的婴儿中进行研究。
