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. 2023 Jun 30;6(6):CD012940.
doi: 10.1002/14651858.CD012940.pub3.

Re-feeding versus discarding gastric residuals to improve growth in preterm infants

Thangaraj Abiramalatha  1   2 , Sivam Thanigainathan  3 , Viraraghavan Vadakkencherry Ramaswamy  4 , Balakrishnan Rajaiah  1 , Srinivas Ramakrishnan  1
Affiliations

Re-feeding versus discarding gastric residuals to improve growth in preterm infants

Thangaraj Abiramalatha et al. Cochrane Database Syst Rev. .

Abstract

Background: 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.

Objectives: 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.

Selection criteria: We selected RCTs that compared re-feeding versus discarding gastric residuals in preterm infants.

Data collection and analysis: 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.

Main results: 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.

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Conflict of interest statement

TA is an Associate Editor of Cochrane Neonatal, but was not otherwise involved in the editorial process or decision‐making for this article.

ST is an Associate Editor of Cochrane Neonatal, was not otherwise involved in the editorial process or decision‐making for this article.

VVR has no interest to declare.

BR has no interest to declare.

SR has no interest to declare.

Figures

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Forest plot of comparison: 1 Refeeding versus discarding gastric residual, outcome: 1.1 Time to regain birth weight (days).
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Forest plot of comparison: 1 Re‐feeding versus discarding gastric residual, outcome: 1.2 Number of Infants with NEC stage 2/3 or SIP.
1.1
1.1. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 1: Time to regain birth weight (days)
1.2
1.2. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 2: Risk of NEC stage ≥ 2 or SIP
1.3
1.3. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 3: All‐cause mortality before hospital discharge
1.4
1.4. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 4: Time to establish full enteral feeds (120 mL/kg/d)
1.5
1.5. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 5: Number of infants with feed interruption episodes (≥ 12 hours)
1.6
1.6. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 6: Number of TPN days
1.7
1.7. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 7: Risk of extrauterine growth restriction (weight < 10th percentile) at discharge
1.8
1.8. Analysis
Comparison 1: Re‐feeding versus discarding gastric residual in preterm infants, Outcome 8: Duration of hospital stay (days)
See this image and copyright information in PMC

Update of

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References to other published versions of this review

Abiramalatha 2018
    1. Abiramalatha T, Thanigainathan S, Balakrishnan U. Re‐feeding versus discarding gastric residuals to improve growth in preterm infants. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No: CD012940. [DOI: 10.1002/14651858.CD012940] - DOI - PMC - PubMed
Abiramalatha 2019
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