A randomised trial of re-feeding gastric residuals in preterm infants

Abstract

Objective: To determine whether re-feeding of gastric residual volumes reduces the time needed to achieve full enteral feeding in preterm infants.

Design: Parallel-group randomised controlled trial with a 1:1 allocation ratio.

Setting: Regional referral neonatal intensive care unit.

Patients: 72 infants of gestational age 23(0/7) to 28(6/7) weeks receiving minimal enteral nutrition (<24 mL/kg/day) during the first week after birth.

Interventions: Infants were randomised to either be re-fed with gastric residual volumes (Re-feeding group) or receive fresh formula/human milk (Fresh-feeding group) whenever large gastric residual volumes were noted.

Main outcome measure: The primary efficacy end point was time to achieve full enteral feeding (≥120 mL/kg/day) after randomisation.

Results: The mean time to full enteral feeding was 10.0 days in the Re-feeding group and 11.3 days in the Fresh-feeding group (mean difference favouring re-feeding: -1.3 days; 95% CI -2.9 to 0.3; p=0.11). The composite safety end point of spontaneous intestinal perforation, surgical necrotising enterocolitis, or death occurred in 6 of 36 infants (17%) in the Re-feeding group versus 10 of 36 infants (28%) in the Fresh-feeding group (p=0.26).

Conclusions: Re-feeding gastric residual volumes in extremely preterm infants does not reduce time to achieve full enteral feeding. This trial suggests that re-feeding might be as safe as fresh feeding, but further research is needed, due to lack of sufficient statistical power in this study for safety analysis.

Trial registration number: NCT01420263NCT01420263.

Keywords: Infant Feeding; Neonatology.