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Summary Background Gastric mucosal ischemia may be a risk factor for gastrointestinal intolerance to early feeding in the critically ill. Aims To study intragastric PCO 2 air tonometry and gastric residual volumes (GRV) before and after the start of gastric feeding. Methods This is a two-center study in intensive care units of a university and teaching hospital. Twenty-nine critically ill, consecutive and consenting patients scheduled to start gastric feeding were studied after insertion of a gastric tonometry catheter and prior to and after start of gastric feeding (500 ml over 1 h), when clinically indicated. Results Blood gasometry and intragastric tonometry were performed prior to and 2 h after gastric feeding. The intragastric to arterial PCO 2 gap (normal <8 mm Hg) was elevated in 41% of patients prior to feeding and measured (mean ± standard deviation) 13 ± 20 and 16 ± 23 mm Hg in patients with normal (<100 ml, 42 ± 34 ml, n = 19) and elevated GRV (250 ± 141 ml, n = 10, P = 0.75), respectively. After feeding, the gradient did not increase and measured 27 ± 25 and 23 ± 34 mm Hg, respectively ( P = 0.80). Conclusion Gastric mucosal ischemia is not a major risk factor for intolerance to early gastric feeding in the critically ill. [ABSTRACT FROM AUTHOR]

It is routine practice in most neonatal intensive care units to measure the volume and color of gastric residuals (GRs) prior to enteral bolus feedings in preterm very low birth weight infants. However, there is paucity of evidence supporting the routine use of this technique. Moreover, owing to the lack of uniform standards in the management of GRs, wide variations exist as to what constitutes significant GR volume, the importance of GR color and frequency of GR evaluation, and the color or volume standards that dictate discarding or returning GRs. The presence of large GR volumes or green-colored residuals prior to feeding often prompts subsequent feedings to be withheld or reduced because of possible necrotizing enterocolitis resulting in delays in enteral feeding. Cessation or delays in enteral feeding may result in extrauterine growth restriction, a known risk factor for poor neurodevelopmental and growth outcomes in preterm very low birth weight infants. Although some neonatal intensive care units are abandoning the practice of routine GR evaluation, little evidence exists to support the discontinuation or continuation of this practice. This review summarizes the current state of GR evaluation and underlines the need for a scientific basis to either support or refute the routine evaluation of GRs. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the effect of body position on gastric residuals at different time points in feeding preterm infants. Further, the results of previous studies are inconsistent. Objectives: To describe the changing pattern of gastric residuals over time in the prone and supine position and to examine the effects of position on gastric residuals at different feeding volumes in preterm infants. Design: A randomized, time series with cross-over study. Setting: A neonatal intensive care unit affiliated with a medical center in central Taiwan. Participants: 35 preterm infants who were asymptomatic for gastroesophageal reflux, other gastrointestinal diseases or other significant morbidities of any kind other than prematurity. Methods: Infants were randomly assigned to the following treatments: 3 h in a supine position followed by 3 h in a prone position, or vice versa. Measurements of gastric residual volume were taken by syringe at 30, 60, 90, 120 and 150 min following feeding when the enteral intake was set at 50 or 100 ml/kg/day. Results: The rate of decrease of gastric residuals in the prone and supine positions was fastest during the first half an hour post-feeding according to measurements taken at 30, 60, 90, 120 and 150 min at feeding volumes of 50 and 100 ml/kg/day (p < 001). Gastric residuals were significantly lower in the prone than in the supine position at the five measurement points. Conclusions: Placing preterm infants in the prone position for the first half an hour post- feeding and then changing the position according to the behavior cues of the infants is suggested. This result contributes to a better understanding of the relationships between time, position, and gastric residuals; it could also help health care professionals to provide efficient feeding as well as perform the appropriate positioning of preterm infants. [ABSTRACT FROM AUTHOR]

Appropriate nutrition is essential for optimal development and growth of preterm infants. Infants less than 25 weeks corrected gestational age are frequently the most difficult group for which to provide adequate nutrition due to minimal energy stores and high fluid losses. Nutrient delivery becomes an integral, but also very challenging part in their management. Early administration of intravenous nutrients provides a critical bridge to full enteral nutrition. However, enteral feeding is challenging due to immaturities of the intestinal tract, feeding intolerance and the risk of catastrophic gastrointestinal disease such as necrotizing enterocolitis (NEC). Decreased gastric acid production, increased gut permeability, reduced immunoglobulins, immature intestinal epithelia and a decreased mucin barrier all contribute to weakness to gastrointestinal insult. This review aims to illustrate the importance of enteral feeding and the common challenges and approaches in the nutrition of infants born at this age. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We determined the variability in enteral feeding practices in mechanically ventilated patients in four adult intensive care units of a tertiary-care, referral hospital. Methods: Patients who had been mechanically ventilated for at least 48 h and received enteral nutrition were prospectively followed. Results: Fifty-five of 101 consecutive mechanically ventilated patients received enteral nutrition; in 93% of patients, feedings were infused into the stomach. Patients who were cared for in the medical intensive care unit, where a nutritional protocol was operational, received enteral nutrition earlier in their ventilatory course (P = 0.004) and feedings were advanced to target rates faster (P = 0.043) than those who received care in other units. The number (P = 0.243) and duration (P = 0.668) of interruptions in feeding did not differ by patient location. On average, patients received only 50% to 70% of their targeted caloric goals during the first 6 days of enteral nutrition. Most feeding discontinuations (41%) were secondary to procedures. Gastrointestinal intolerances, including vomiting, aspiration, abdominal distention, and increased gastric residuals, were uncommon despite allowing gastric residuals up to 300 mL. Conclusions: The practice of providing enteral feeds to mechanically ventilated patients varies widely, even within one hospital. A protocol enhanced early initiation of enteral feeds and advancement to target feeding rates but did not alter the number or duration of interruptions in enteral feedings. Procedures represented the most common reason for stopping enteral feeds, and gastrointestinal intolerances (vomiting, aspiration, and increased gastric residuals) caused few feeding interruptions. The gastric route was safe and well tolerated for early enteral feeding in most mechanically ventilated patients. [Copyright &y& Elsevier]