title: The significance of gastric residuals in the early enteral feeding advancement of extremely low birth weight infants.
abstract: OBJECTIVE
  To evaluate whether the mean gastric residual volume (GRV) and green gastric residuals (GR) themselves are significant predictors of feeding intolerance in the early enteral feeding advancement in extremely low birth weight (ELBW; <1000 g) infants.
  
  
  METHODS
  Ninety-nine ELBW infants were fed following a standardized protocol (day 3--14). At 48 hours of age, milk feeding was started (12 mL/kg/d increments, 12 meals per day). GR were checked before each feeding, and a GRV up to 2 mL/3 mL in infants less-than-or-equal750 g/>750 g was tolerated. In cases of increased GRV, feedings were reduced or withheld. The color of GR was assessed as clear, milky, green-clear, green-cloudy, blood-stained, or hemorrhagic. Multiple regression analysis was used to study the effect of the mean GRV and the color of GR on the feeding volume on day 14 (V14).
  
  
  RESULTS
  The median V14 was 103 mL/kg/d (0--166). V14 increased with an increasing percentage of milky GR, whereas the mean GRV and the color green did not have a significant effect.
  
  
  CONCLUSIONS
  1) Early enteral feeding could be established in ELBW infants. The critical GRV seems to be above 2 mL/3 mL because there was no significant negative correlation between the mean GRV and V14. 2) Green GR were not negatively correlated with V14 and should not slow down the advancement of feeding volumes in absence of other clinical signs and symptoms.
authors.affiliation: Division of Neonatology and Pediatric Critical Care Medicine, Department of Pediatrics, University of Ulm, Ulm, Germany.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Mihatsch
authors.forename: Patrik
authors.initials: P
authors.lastname: von Schoenaich
authors.forename: Hubert
authors.initials: H
authors.lastname: Fahnenstich
authors.forename: Norma
authors.initials: N
authors.lastname: Dehne
authors.forename: Hartmut
authors.initials: H
authors.lastname: Ebbecke
authors.forename: Christian
authors.initials: C
authors.lastname: Plath
authors.forename: Hans-Burkhardt
authors.initials: HB
authors.lastname: von Stockhausen
authors.forename: Rainer
authors.initials: R
authors.lastname: Muche
authors.forename: Axel
authors.initials: A
authors.lastname: Franz
authors.forename: Frank
authors.initials: F
authors.lastname: Pohlandt
mesh_terms: D000465:Algorithms; D004750:Enteral Nutrition / Q000379:methods; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D007225:Infant Food / Q000032:analysis; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008895:Milk, Human; D012044:Regression Analysis; D013270:Stomach