title: Evaluation of potential factors predicting attainment of full gavage feedings in preterm infants.
abstract: BACKGROUND
  The clinical measures of gastric residuals and abdominal distention are often used to guide feeding in preterm infants, but there are few data demonstrating their usefulness. Similarly, techniques are now available to investigate gastrointestinal (GI) function noninvasively and safely, but their ability to predict attainment of full gavage feedings and/or feeding volume in preterm infants is unclear.
  
  
  OBJECTIVE
  We sought to determine prospectively the potential relationships of attainment of full gavage feedings and feeding volume with clinical measures and noninvasive GI tests.
  
  
  METHODS
  Fifty preterm infants were followed prospectively. Daily tally was taken of gavage feeding intake, gastric residual volumes (GRVs; milliliters per day, number of GRVs >50% of the previous feeding volume, and number of GRVs >2 ml/kg), and abdominal distention. Infants underwent repeated measurement of lactase activity, GI permeability, fecal calprotectin concentration, and gastric emptying.
  
  
  RESULTS
  The number of GRVs >2 ml/kg tended to decrease with postnatal age (p = 0.06). Lactase activity and feeding volume in milliliters per kilogram per day prior to achieving full feedings were correlated (p = 0.007, β = 0.164). There was no correlation between feeding outcomes and GRV (ml/day), GRV >50%, GRV >2 ml/kg, small bowel, colonic, or whole bowel permeability, fecal calprotectin concentration, gastric emptying, or abdominal distention.
  
  
  CONCLUSIONS
  GRV is unreliable in predicting attainment of full gavage feeding. Lactase activity is related to feeding volume. However, other noninvasive GI tests utilized were not predictive. These data cast doubt upon the utility of GRV in guiding feeding therapy. Randomized trials of different GRV management protocols are needed.
authors.affiliation: Department of Pediatrics, Children's Nutrition Research Center, Houston, Tex 77030-2600, USA. rshulman @ bcm.tmc.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Shulman
authors.forename: Ching-Nan
authors.initials: CN
authors.lastname: Ou
authors.forename: E O'Brian
authors.initials: EO
authors.lastname: Smith
mesh_terms: D004435:Eating / Q000502:physiology*; D004750:Enteral Nutrition / Q000379:methods*; D005243:Feces / Q000737:chemistry; D005247:Feeding Behavior / Q000502:physiology; D005746:Gastric Emptying; D005766:Gastrointestinal Contents; D005865:Gestational Age; D006801:Humans; D007225:Infant Food; D007231:Infant, Newborn; D007234:Infant, Premature; D007441:Intubation, Gastrointestinal; D043322:Lactase; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D010351:Patient Discharge; D011446:Prospective Studies
chemical_list: D039841:Leukocyte L1 Antigen Complex; D043322:Lactase