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Abstract The practice of routine gastric residual aspiration in preterm infants remains controversial, with conflicting evidence regarding its impact on necrotizing enterocolitis (NEC). As front-line caregivers, nurses play a vital role in gastric aspiration procedures and must be informed by evidence. This quasi-experimental nursing study aimed to assess whether gastric aspiration is clinically relevant in reducing the risk of NEC in preterm infants. A total of 250 preterm infants from two NICUs in Egypt were allocated to the gastric aspiration (n = 125) and non-aspiration (n = 125) groups. Feeding practices, gastric residuals, and incidence/severity of NEC were compared between groups according to modified Bell’s criteria. Risk factors were analyzed using multivariate regression. There were no significant baseline differences between the groups. The gastric residual attributes and feeding outcomes did not differ substantially from aspiration. The overall incidence of NEC was 14–15%, with no significant differences in the odds of onset or progression of NEC by stage between the groups. Lower gestational age and birth weight emerged as stronger predictors of NEC. Routine gastric aspiration does not appear to directly prevent or reduce the severity of NEC in this population. Although gastric residuals retain clinical importance, study findings question assumptions that aspiration protects against NEC and informs nursing practice. Evidence-based feeding protocols must continually evolve through ongoing research on modifiable risk factors for this devastating intestinal disease in preterm infants.

Abstract Background The enteral route is commonly utilised to support the nutritional requirements of critically ill patients. However, there is paucity of data guiding clinicians regarding the appropriate method of delivering the prescribed dose. Continuous enteral feeding is commonly used; however, a bolus or intermittent method of administration may provide several advantages such as minimising interruptions. The purpose of this meta-analysis is to compare a continuous versus an intermittent or bolus enteral nutrition administration method. Methods A systematic review and meta-analysis were performed with studies identified from the PubMed, EMBASE, Cochrane Library and Web of Science databases. Studies were included if they compared a continuous with either an intermittent or bolus administration method of enteral nutrition in adult patients admitted to the intensive care unit. Study quality was assessed using the PEDro and Newcastle–Ottawa scoring systems. Review Manager was used for performing the random-effects meta-analysis on the outcomes of mortality, constipation, diarrhoea, increased gastric residuals, pneumonia, and bacterial colonisation. Results A total of 5546 articles were identified, and 133 were included for full text review. Fourteen were included in the final analysis. There was an increased risk of constipation with patients receiving continuous enteral nutrition (relative risk 2.24, 95% confidence interval 1.01–4.97, p = 0.05). No difference was identified in other outcome measures. No appreciable bias was identified. Conclusion The current meta-analysis has not identified any clinically relevant difference in most outcome measures relevant to the care of critically ill patients. However, there is a paucity of high-quality randomised controlled clinical trials to guide this decision. Therefore, clinicians may consider either dosing regimen in the context of the patient’s care requirements.

To evaluate whether eliminating routine gastric residual volume (GRV) assessments would lead to quicker attainment of full feeding volumes in preterm infants. This is a prospective randomized controlled trial of infants ≤32 weeks gestation and birthweight ≤1250 g admitted to a tertiary care NICU. Infants were randomized to assess or not assess GRV before enteral tube feedings. The primary outcome was time to attain full enteral feeding volume defined as 120 ml/kg/day. The Wilcoxon rank sum test was used to compare the days to reach full enteral feeds between the two groups. 80 infants were randomized, 39 to the GRV assessing and 41 to the No-GRV assessing group. A predetermined interim analysis at 50% enrollment showed no difference in primary outcome and the study was stopped as recommended by the Data Safety Monitoring Committee. There was no significant difference in median days to reach full enteral feeds between the two groups [GRV assessment: 12d (5) vs. No-GRV assessment:13d (9)]. There was no mortality in either group, one infant in each group developed necrotizing enterocolitis stage 2 or greater. Eliminating the practice of gastric residual volume assessment before feeding did not result in shorter time to attain full feeding. [ABSTRACT FROM AUTHOR]

Background: The enteral route is commonly utilised to support the nutritional requirements of critically ill patients. However, there is paucity of data guiding clinicians regarding the appropriate method of delivering the prescribed dose. Continuous enteral feeding is commonly used; however, a bolus or intermittent method of administration may provide several advantages such as minimising interruptions. The purpose of this meta-analysis is to compare a continuous versus an intermittent or bolus enteral nutrition administration method.Methods: A systematic review and meta-analysis were performed with studies identified from the PubMed, EMBASE, Cochrane Library and Web of Science databases. Studies were included if they compared a continuous with either an intermittent or bolus administration method of enteral nutrition in adult patients admitted to the intensive care unit. Study quality was assessed using the PEDro and Newcastle-Ottawa scoring systems. Review Manager was used for performing the random-effects meta-analysis on the outcomes of mortality, constipation, diarrhoea, increased gastric residuals, pneumonia, and bacterial colonisation.Results: A total of 5546 articles were identified, and 133 were included for full text review. Fourteen were included in the final analysis. There was an increased risk of constipation with patients receiving continuous enteral nutrition (relative risk 2.24, 95% confidence interval 1.01-4.97, p = 0.05). No difference was identified in other outcome measures. No appreciable bias was identified.Conclusion: The current meta-analysis has not identified any clinically relevant difference in most outcome measures relevant to the care of critically ill patients. However, there is a paucity of high-quality randomised controlled clinical trials to guide this decision. Therefore, clinicians may consider either dosing regimen in the context of the patient's care requirements. [ABSTRACT FROM AUTHOR]

Necrotising enterocolitis (NEC) is a potentially serious illness with significant mortality and morbidity in preterm infants. Previous studies have reported association of volume and colour (bile and blood stained) of gastric residuals (GR) with NEC. We aimed to study this association in our cohort of extremely preterm (EP) infants. In a case–control study using retrospective data (January 2006–December 2011), EP (gestation < 28 weeks) infants with confirmed NEC ≥ stage II (cases) were compared with infants without NEC (controls) matched for birth weight (BW) and gestational age (GA). Forty cases of NEC ≥ stage II diagnosed at a median (IQR) age of 16.5 days (10.3–23) were compared with 40 controls matched for gestation (± 3 days) and birth weight (± 680 g). Median maximum GR volume (GRV) from birth to the day of occurrence of NEC was significantly higher in cases vs. controls (5.9 vs.3.7 ml; p < 0.001). Increased maximum GRV was associated with NEC ≥ Stage II in adjusted analysis (aOR 1.36, 95%CI 1.06–1.75, p = 0.017). There was no significant difference in GRV between cases and controls throughout the clinical course, including 72, 48 and 24 h before the onset of NEC. However, green (65.0% vs. 27.5%, p = 0.001) and haemorrhagic GRs (45.0% vs. 27.5%, p = 0.092) were higher 24 h before the diagnosis of NEC. Conclusion: GRV was not associated with NEC ≥ stage II. However, green and haemorrhagic GRs were significantly higher 24 h before the diagnosis of the illness. Adequately powered prospective studies are needed to confirm the significance of our findings. What is Known: •It is unclear whether large volume, dark-coloured and blood-stained GRs are associated with NEC. •The value of routine monitoring of gastric residuals in preterm infants is currently being questioned. What is New: •Volume of gastric residuals was not associated with significant NEC. •Green and haemorrhagic GRs were significantly higher 24 hours before diagnosis of NEC. [ABSTRACT FROM AUTHOR]

Purpose : The routine evaluation of gastric residuals (RGR) is considered standard care for premature infants. This study evaluated the usefulness of RGR in premature infants. Methods : The study retrospectively inves- tigated 208 premature infants (gestational aged under 34 weeks) who underwent gavage feeding in a neonatal intensive care unit at a tertiary hospital. The patients were divided into two groups: RGR (n=104) and no-RGR (n=104). Those in the no-RGR group had their gastric residuals checked only if signs of feeding in- tolerance were present. Clinical outcomes, including the time to reach full enteral feeding (FEF) and the incidences of gastrointestinal disorders such as feeding intolerance (FI) and necrotizing enterocolitis (NEC), were compared. Data were analyzed with SPSS ver. 21, using a Mann-Whitney U test, chi-squared test, and Fisher's exact test. Results : There was no statistically significant difference for the time to FEF (z=-0.61, p=.541), in- cidence of FI (X² =0.38, p=.540), and NEC (X² =1.42, p=.234) between the two groups. Conclusion : No-RGR did not increase the risk for FI or NEC. These results suggest that RGR evaluation may not improve nutritional outcomes in premature infants. Recommendations for further research and practice guidelines will be provided. [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.

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]

The routine aspiration of gastric residuals (GR) is considered standard care for critically ill infants in the neonatal intensive care unit (NICU). Unfortunately, scant information exists regarding the risks and benefits associated with this common procedure. This article provides the state of the science regarding what is known about the routine aspiration and evaluation of GRs in the NICU focusing on the following issues: (1) the use of GRs for verification of feeding tube placement, (2) GRs as an indicator of gastric contents, (3) GRs as an indicator of feeding intolerance or necrotizing enterocolitis, (4) the association between GR volume and ventilator-associated pneumonia, (5) whether GRs should be discarded or refed, (6) the definition of an abnormal GR, and (7) the potential risks associated with aspiration and evaluation of GRs. Recommendations for further research and practice guidelines are also provided. [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]

Objectives: To evaluate the effectiveness of high-dose erythromycin to treat feeding intolerance in preterm infants predominantly fed milk formula. Design: This study is a prospective randomized controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin ethylsuccinate at a dose of 50 mg/kg/day for 10 days or until they reached full enteral feeds. Randomization was stratified according to gestational age <32 weeks or ≥32 weeks gestation. The primary end point was the time taken to establish full enteral feeding since enrollment. Potential adverse effects associated with erythromycin were also monitored. Student's t test was used for comparison of continuous variables and χ2for categorical data. Results: In infants <32 weeks, the use of erythromycin was associated with more daily weight gain (12.8 ± 2.6 g vs. 9.2 ± 5.3 g, p = 0.04) compared to the control group. Time to reach full feed did not differ between the erythromycin (13.8 ± 3.9 days) and the control (17.46 ± 4.9 days) groups (p = 0.07). In infants ≥32 weeks, there were no differences between the erythromycin and the control groups. Conclusion: High-dose erythromycin is associated with greater weight gain in preterm infants <32 weeks gestational age, who are predominantly fed cow's milk-based protein formulas. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: To evaluate the efficacy and safety of minimal enteral feeding (MEF) nutritional practice in feed-intolerant very low birth weight (VLBW) infants. Methods: A retrospective design using data reported in the clinical charts of VLBW newborns consecutively observed in neonatal intensive care units (NICU) that presents feed intolerance. During the study period, two feeding strategies were adopted: total parenteral nutrition (PN) (group 1) or PN plus MEF (group 2), for at least 24 h. Primary outcome was the time to reach full enteral feeding; secondary outcomes were the occurrence of sepsis, the time to regain birth weight, the length of hospitalization, the occurrence of necrotizing enterocolitis (NEC) Bell stage >II and death. Results: In total, 102 newborns were evaluated: 51 in group 1, and 51 in group 2. Neonates in group 2 achieved full enteral nutrition earlier (8 days, interquartile range [IQR] 5) compared with subjects receiving total PN (11 days, IQR 5, p < 0.001). A reduction of sepsis episodes was observed in group 2 (15.7%) compared with group 1 (33.3%, p = 0.038). Additionally, subjects in group 2 regained their birth weight and were discharged earlier. The occurrence of NEC and death were similar in the two groups. Conclusion: Minimal enteral feeding in very low birth weight infants presenting feed intolerance reduces the time to reach full enteral feeding and the risk of sepsis. This feeding practice does not increase the risk of necrotizing enterocolitis and death. [ABSTRACT FROM AUTHOR]

Objectives:To evaluate the effectiveness of low-dose oral erythromycin to treat feeding intolerance in preterm infants.Design:This study was a prospective, double-blind, randomized, placebo-controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin 1 mg/kg every 8 h and 30 infants were given placebo (normal saline). Randomization was stratified on enrollment according to gestational age whether >32 weeks or 32 weeks. The primary end point was the length of time taken to establish full enteral feeding since enrollment. Potential adverse effects associated with erythromycin were also monitored. Groups of each corresponding stratum were compared using two-tail t-test and Mann–Whitney for continuous variables, and χ2 and Fisher's exact for categorical variables.Results:For infants with gestational age >32 weeks, the erythromycin group achieved full enteral feeding earlier than placebo group (10.5±4.1 vs 16.3±5.7 days, respectively; P=0.01) had fewer episodes of gastric residuals (P<0.05) and shorter duration of parenteral nutrition (PN) (P<0.05). On the other hand, in infants with gestational age 32 weeks, there were no significant differences between erythromycin and placebo groups regarding any of these variables.Conclusion:Low-dose enteral erythromycin is associated with better tolerance of feeding and shorter duration of PN in infants >32 weeks gestation. A similar effect on younger preterm infants was not demonstrable.Journal of Perinatology (2007) 27, 39–43. doi:10.1038/sj.jp.7211618; published online 12 October 2006 [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]

Aim: Early human milk feeding is beneficial for gut and brain development. Persistent ductus arteriosus (PDA) and indomethacin may compromise enteral function in preterm infants. For many years enteral milk feedings have continued in preterm infants receiving indomethacin for PDA. The aim of this study was to investigate whether this strategy is efficient in terms of risks and tolerance to early enteral feeding.Methods: This retrospective study included 64 inborn infants of <29 wk gestational age (GA), 32 infants who received indomethacin for symptomatic PDA (case infants) and 32 matched controls. Case infants had a mean (SD) GA of 26.3 wk (1.3) and body weight 839 g (203) versus controls GA 26.4 wk (1.2) and body weight 896 g (213) (p = 0.82 and 0.27, respectively). Case infants had higher respiratory morbidity; 90.6% versus 50% of controls needed mechanical ventilation (p = 0.000).Results: Case infants received human milk from a median (range) age of 4.0 h (1.5-27.5), and controls from 5.3 h (2.0-38.0) (p = 0.092). The first dose of indomethacin was given at a mean age of 1.7 d (1.0). There were no differences between the two groups in feeding volumes or gastric residuals on days 1 to 7. Mean (SD) feeding volume on day 7 was 64 ml/kg (31) in case infants and 76 ml/kg (30) in controls (p = 0.23). Four infants developed necrotizing enterocolitis: two case infants and two controls (p = 1.00).Conclusion: Early enteral feeding with human milk, starting within the first hours of life, seems to be as well tolerated in preterm infants treated with indomethacin for PDA as in their matched controls. [ABSTRACT FROM AUTHOR]

Background: Early enhanced enteral nutrition (EN) improves clinical outcome in severe head injury. However, poor gastric emptying and certain aspects of intensive care may inhibit delivery of optimum nutrition. Aim: To determine the important causes of interruption to EN and whether attempting early adequate EN could enhance nutritional intake in severe head injury. Methods: Eighty-two patients were randomized to receive either standard EN or early adequate EN. Data was collected on nutritional intake, causes of interruption to EN, nitrogen balance, volume of gastric residuals and incidence of pneumonia. Results: The median percentage of energy and nitrogen delivered was greater in intervention patients compared to controls over the first week post-injury (P < 0.02). During the first 96 h post-injury, patients received EN during 57% of the potential feeding time. Intervention patients received a higher fluid volume (P < 0.02) but did not have a higher incidence of pneumonia. Conclusion: Taking into account the importance of initiating and maintaining adequate EN, prioritizing procedures in intensive therapy units could further improve nutritional intake in severe head injury. [ABSTRACT FROM AUTHOR]

Postnatal growth restriction and failure to thrive is a major issue in preterm, especially extremely low-birth-weight infants. Optimization of enteral nutrition, without increasing the risk of necrotizing enterocolitis (NEC), has thus become a priority for the neonatologist, who often has to face the challenge of interpreting the clinical and prognostic significance of common and aspecific signs of feeding intolerance (FI). The neonatologist often prescribes enteral nutrition as if walking on a tightrope between the purposed attainment of full enteral feeding and the fear of NEC. Despite advances in neonatal intensive care, NEC still remains one of the leading causes of mortality (15-30%) and morbidity in very-low-birth-weight infants. However, the relationship between FI and NEC remains unknown. Feeding intolerance often leads to discontinuation of enteral feeds, delayed attainment of full enteral feeding and prolongation of hospitalization. Strategies aimed at preventing and/or treating episodes of feeding intolerance are diverse and not always supported by scientific evidence. [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: 3h in a supine position followed by 3h 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 100ml/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 100ml/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., (Copyright © 2013 Elsevier Ltd. All rights reserved.)