A. K MALHOTRA ET AL.
Brief Report
Gastric Residuals in Preterm Babies by A. K. Malhotra, A. K. Deorari, V. K. Paul, A. Bagga, and Meharban Singh Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi—110 029, India
Introduction The feeding of pretenn babies demands considerable skill and care; each nursery evolves its own feeding schedule. In principle, basic considerations are the volume of the feed, type of formula, duration tx%veen successive feeds, gastric residual volume and prevention of associated complications. The emptying time of stomach and its residual capacity in pretenn infants has a direct relationship with the volume and schedule of feeding. This study was undertaken to measure the normal gastric residual (GR) secretion in healthy preterm babies; to compare the effect of expressed breastmilk (EBM) v. milk formula (MF) and posture on GR volume. Finally, an attempt was made to correlate the abdominal girth with residuals.
Materials and Methods Fifty consecutive pretenn (PT) babies admitted to the neonatal intensive care unit at our hospital during February to September 1989 were included in the study. The gestational age was calculated by dates and confirmed by the modified scoring system.1 Sick babies with problems of birth asphyxia, respiratory distress, jaundice, sepsis, major congenital anomalies or requiring ventilation were excluded from the study. A sterile No. 5 French size feeding tube was passed through the nose after measuring the length from Correspondence: Professor Meharban Singh, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi—110 029, India. 262
© Oxford University Press 1992
nostril to tragus and extending the same to xiphoid cartilage. The tube was left in situ and whenever the neonate pulled it out, another sterile tube was reintroduced. Healthy neonates on exclusive intravenous fluids were analysed for basal gastric residuals. To obviate inter-personal enor, three readings at 4-hourly intervals were taken daily by one of us (A.K.M.) during the first week of life. These have been labelled by us as Basal 4-hour Gastric Residuals (B4 GR). A measured quantity of feed, starting at 60 ml per kg body weight and increased by 10 ml/kg every day was given at 2-hourly interval. Overall clinical condition and tolerance to feeds were used as factors for starting enteral feeding. Babies were on a conservative feeding schedule so as to decrease the chances of common feeding problems. The gastric residuals from previous feed were noted. The non-bilious aspirates were returned back. These were measured in the syringe and expressed as percentage of feed given. The mean of three readings was recorded. Thus, 50 neonates had three readings each day for a period of 7 days. The preand post-feed abdominal girth was recorded. We found that the subcostal abdominal girth correlated better with GR than the abdominal girth taken at the level of umbilicus. The abdominal distension first appears in the epigastric region as fullness and stretched skin. Neonates were either exclusively breastmilk (EBM) or milk formula (MF) fed and were randomly put either in prone or supine position until next feed to assess the effect of posture on GR. None of the neonates received drugs like metoclopromide or Journal of Tropical Pediatrics
Vol. 38
October 1992
Downloaded from http://tropej.oxfordjournals.org/ at University of California, Santa Barbara on August 23, 2015
Summary The gastric residual (GR) volume was measured in 50 healthy preterm babies, 38 appropriate-for-dates (AFD), and 12 small-for-dates (SFD) with gestationa! age of 28-36 weeks. The mean basal 4-hour gastric residual (B4 GR) volume was 2.8 ± 0.63 ml in parenterally fed babies. There was a marked decrease in the residuals from 20.7± 15.2 per cent (mean ± SD) on day 4to 8.6 + 4.3 per cent on day 7(/'
Brief Report
Gastric Residuals in Preterm Babies by A. K. Malhotra, A. K. Deorari, V. K. Paul, A. Bagga, and Meharban Singh Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi—110 029, India
Introduction The feeding of pretenn babies demands considerable skill and care; each nursery evolves its own feeding schedule. In principle, basic considerations are the volume of the feed, type of formula, duration tx%veen successive feeds, gastric residual volume and prevention of associated complications. The emptying time of stomach and its residual capacity in pretenn infants has a direct relationship with the volume and schedule of feeding. This study was undertaken to measure the normal gastric residual (GR) secretion in healthy preterm babies; to compare the effect of expressed breastmilk (EBM) v. milk formula (MF) and posture on GR volume. Finally, an attempt was made to correlate the abdominal girth with residuals.
Materials and Methods Fifty consecutive pretenn (PT) babies admitted to the neonatal intensive care unit at our hospital during February to September 1989 were included in the study. The gestational age was calculated by dates and confirmed by the modified scoring system.1 Sick babies with problems of birth asphyxia, respiratory distress, jaundice, sepsis, major congenital anomalies or requiring ventilation were excluded from the study. A sterile No. 5 French size feeding tube was passed through the nose after measuring the length from Correspondence: Professor Meharban Singh, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi—110 029, India. 262
© Oxford University Press 1992
nostril to tragus and extending the same to xiphoid cartilage. The tube was left in situ and whenever the neonate pulled it out, another sterile tube was reintroduced. Healthy neonates on exclusive intravenous fluids were analysed for basal gastric residuals. To obviate inter-personal enor, three readings at 4-hourly intervals were taken daily by one of us (A.K.M.) during the first week of life. These have been labelled by us as Basal 4-hour Gastric Residuals (B4 GR). A measured quantity of feed, starting at 60 ml per kg body weight and increased by 10 ml/kg every day was given at 2-hourly interval. Overall clinical condition and tolerance to feeds were used as factors for starting enteral feeding. Babies were on a conservative feeding schedule so as to decrease the chances of common feeding problems. The gastric residuals from previous feed were noted. The non-bilious aspirates were returned back. These were measured in the syringe and expressed as percentage of feed given. The mean of three readings was recorded. Thus, 50 neonates had three readings each day for a period of 7 days. The preand post-feed abdominal girth was recorded. We found that the subcostal abdominal girth correlated better with GR than the abdominal girth taken at the level of umbilicus. The abdominal distension first appears in the epigastric region as fullness and stretched skin. Neonates were either exclusively breastmilk (EBM) or milk formula (MF) fed and were randomly put either in prone or supine position until next feed to assess the effect of posture on GR. None of the neonates received drugs like metoclopromide or Journal of Tropical Pediatrics
Vol. 38
October 1992
Downloaded from http://tropej.oxfordjournals.org/ at University of California, Santa Barbara on August 23, 2015
Summary The gastric residual (GR) volume was measured in 50 healthy preterm babies, 38 appropriate-for-dates (AFD), and 12 small-for-dates (SFD) with gestationa! age of 28-36 weeks. The mean basal 4-hour gastric residual (B4 GR) volume was 2.8 ± 0.63 ml in parenterally fed babies. There was a marked decrease in the residuals from 20.7± 15.2 per cent (mean ± SD) on day 4to 8.6 + 4.3 per cent on day 7(/'
