Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India.
KMCH Research Foundation, Coimbatore, Tamil Nadu, India.
Cochrane Database Syst Rev. 2023 Jun 30;6(6):CD012940. doi: 10.1002/14651858.CD012940.pub3.
Routine monitoring of gastric residuals in preterm infants on tube feeds is a common practice in neonatal intensive care units used to guide initiation and advancement of enteral feeding. There is a paucity of consensus on whether to re-feed or discard the aspirated gastric residuals. While re-feeding gastric residuals may aid in digestion and promote gastrointestinal motility and maturation by replacing partially digested milk, gastrointestinal enzymes, hormones, and trophic substances, abnormal residuals may result in vomiting, necrotising enterocolitis, or sepsis.
To assess the efficacy and safety of re-feeding when compared to discarding gastric residuals in preterm infants. SEARCH METHODS: Searches were conducted in February 2022 in Cochrane CENTRAL via CRS, Ovid MEDLINE and Embase, and CINAHL. We also searched clinical trial databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs.
We selected RCTs that compared re-feeding versus discarding gastric residuals in preterm infants.
Review authors assessed trial eligibility and risk of bias and extracted data, in duplicate. We analysed treatment effects in individual trials and reported the risk ratio (RR) for dichotomous data and the mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence.
We found one eligible trial that included 72 preterm infants. The trial was unmasked but was otherwise of good methodological quality. Re-feeding gastric residual may have little or no effect on time to regain birth weight (MD 0.40 days, 95% CI -2.89 to 3.69; 59 infants; low-certainty evidence), risk of necrotising enterocolitis stage ≥ 2 or spontaneous intestinal perforation (RR 0.71, 95% CI 0.25 to 2.04; 72 infants; low-certainty evidence), all-cause mortality before hospital discharge (RR 0.50, 95% CI 0.14 to 1.85; 72 infants; low-certainty evidence), time to establish enteral feeds ≥ 120 mL/kg/d (MD -1.30 days, 95% CI -2.93 to 0.33; 59 infants; low-certainty evidence), number of total parenteral nutrition days (MD -0.30 days, 95% CI -2.07 to 1.47; 59 infants; low-certainty evidence), and risk of extrauterine growth restriction at discharge (RR 1.29, 95% CI 0.38 to 4.34; 59 infants; low-certainty evidence). We are uncertain as to the effect of re-feeding gastric residual on number of episodes of feed interruption lasting for ≥ 12 hours (RR 0.80, 95% CI 0.42 to 1.52; 59 infants; very low-certainty evidence).
AUTHORS' CONCLUSIONS: We found only limited data from one small unmasked trial on the efficacy and safety of re-feeding gastric residuals in preterm infants. Low-certainty evidence suggests re-feeding gastric residual may have little or no effect on important clinical outcomes such as necrotising enterocolitis, all-cause mortality before hospital discharge, time to establish enteral feeds, number of total parenteral nutrition days, and in-hospital weight gain. A large RCT is needed to assess the efficacy and safety of re-feeding of gastric residuals in preterm infants with adequate certainty of evidence to inform policy and practice.
在新生儿重症监护病房，常规监测早产儿的胃残留量是一种常见的做法，用于指导肠内喂养的开始和推进。对于是否应该重新喂养或丢弃吸出的胃残留量，缺乏共识。虽然重新喂养胃残留量可以通过替代部分消化的牛奶、胃肠道酶、激素和营养物质来帮助消化和促进胃肠道蠕动和成熟，但异常的残留量可能导致呕吐、坏死性小肠结肠炎或败血症。
评估与丢弃胃残留量相比，重新喂养早产儿的疗效和安全性。
2022 年 2 月，我们在 Cochrane 中心通过 CRS、Ovid MEDLINE 和 Embase 以及 CINAHL 进行了检索。我们还检索了临床试验数据库、会议记录以及检索到的文章的参考文献列表，以查找随机对照试验（RCT）和准随机对照试验。
我们选择了比较重新喂养与丢弃胃残留量在早产儿中的疗效和安全性的 RCT。
综述作者评估了试验的纳入标准和偏倚风险，并进行了重复数据提取。我们在个体试验中分析了治疗效果，并报告了二分类数据的风险比（RR）和连续数据的均数差（MD），以及各自的 95%置信区间（CI）。我们使用 GRADE 方法评估证据的确定性。
我们发现了一项符合条件的试验，该试验纳入了 72 名早产儿。该试验未设盲，但方法学质量良好。重新喂养胃残留可能对恢复出生体重的时间（MD 0.40 天，95%CI -2.89 至 3.69；59 名婴儿；低质量证据）、坏死性小肠结肠炎≥2 级或自发性肠穿孔的风险（RR 0.71，95%CI 0.25 至 2.04；72 名婴儿；低质量证据）、出院前全因死亡率（RR 0.50，95%CI 0.14 至 1.85；72 名婴儿；低质量证据）、达到 120 mL/kg/d 的肠内喂养时间（MD -1.30 天，95%CI -2.93 至 0.33；59 名婴儿；低质量证据）、总肠外营养天数（MD -0.30 天，95%CI -2.07 至 1.47；59 名婴儿；低质量证据）和出院时宫外生长受限的风险（RR 1.29，95%CI 0.38 至 4.34；59 名婴儿；低质量证据）没有影响。我们不确定重新喂养胃残留对持续时间≥12 小时的喂养中断次数的影响（RR 0.80，95%CI 0.42 至 1.52；59 名婴儿；极低质量证据）。
我们仅从一项小型非盲试验中获得了关于重新喂养早产儿胃残留量的疗效和安全性的有限数据。低质量证据表明，重新喂养胃残留量可能对重要的临床结局（如坏死性小肠结肠炎、出院前全因死亡率、达到肠内喂养的时间、总肠外营养天数和住院体重增加）没有影响。需要一项大型 RCT 来评估重新喂养早产儿胃残留量的疗效和安全性，以获得足够确定度的证据来为政策和实践提供信息。
