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. 2020 Aug 7;4(1):e000601.
doi: 10.1136/bmjpo-2019-000601. eCollection 2020.

Gastric residual volume measurement in British neonatal intensive care units: a survey of practice

Jon Dorling  1 , Lyvonne Tume  2 , Barbara Arch  3 , Kerry Woolfall  4 , Lynne Latten  5 , Louise Roper  4 , Elizabeth Deja  4 , Nazima Pathan  6 , Helen Eccleson  3 , Helen Hickey  3 , Michaela Brown  3 , Anne Beissel  7 , Izabela Andrzejewska  8 , Frederic Valla  9 , Chris Gale  10
Affiliations

Gastric residual volume measurement in British neonatal intensive care units: a survey of practice

Jon Dorling et al. BMJ Paediatr Open. .

Abstract

Objective: Despite little evidence, the practice of routine gastric residual volume (GRV) measurement to guide enteral feeding in neonatal units is widespread. Due to increased interest in this practice, and to examine trial feasibility, we aimed to determine enteral feeding and GRV measurement practices in British neonatal units.

Design and setting: An online survey was distributed via email to all neonatal units and networks in England, Scotland and Wales. A clinical nurse, senior doctor and dietitian were invited to collaboratively complete the survey and submit a copy of relevant guidelines.

Results: 95/184 (51.6%) approached units completed the survey, 81/95 (85.3%) reported having feeding guidelines and 28 guidelines were submitted for review. The majority of units used intermittent (90/95) gastric feeds as their primary feeding method. 42/95 units reported specific guidance for measuring and interpreting GRV. 20/90 units measured GRV before every feed, 39/90 at regular time intervals (most commonly four to six hourly 35/39) and 26/90 when felt to be clinically indicated. Most units reported uncertainty on the utility of aspirate volume for guiding feeding decisions; 13/90 reported that aspirate volume affected decisions 'very much'. In contrast, aspirate colour was reported to affect decisions 'very much' by 37/90 of responding units. Almost half, 44/90, routinely returned aspirates to the stomach.

Conclusions: Routine GRV measurement is part of standard practice in British neonatal units, although there was inconsistency in how frequently to measure or how to interpret the aspirate. Volume was considered less important than colour of the aspirate.

Keywords: gastroenterology; measurement; neonatology.

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Conflict of interest statement

Competing interests: JD reports grants from National Institute for Health Research (NIHR), during the conduct of the study; grants from NIHR, grants from Nutrinia, outside the submitted work. LT reports grant from NIHR, during the conduct of the study. ED reports grants from NIHR Health Technology Assessment (HTA) programme during the conduct of the study. HE reports grants from NIHR HTA during the conduct of the study. HH reports this grant from NIHR HTA, during the conduct of the study. MB reports grants from NIHR HTA during the conduct of the study. CG reports grants from NIHR, during the conduct of the study; grants from NIHR, grants from Medical Research Foundation, grants from Mason Medical Research Foundation, grants and personal fees from Chiesi Pharmaceuticals, grants from Rosetrees Foundation, grants from Canadian Institute for Health Research, outside the submitted work. FV reports personal fees from Baxter, personal fees from Nutricia, outside the submitted work. LT reports grants from NIHR during the conduct of the study.

Figures

Figure 1
Figure 1
Perceived importance of aspirate volume and colour for making feeding decisions.
See this image and copyright information in PMC

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