Should we be checking gastric residuals in premature infants?

Hey everyone, and welcome to this new guest video review series in collaboration with the American Pediatric Surgical Association. If you ever find it challenging to identify what articles are important, know that your APSA Committees are working together to highlight the practice changing literature you should know. Dr. Arun Thenappan from Children's National Hospital in DC, representing the APSA Critical Care Committee, joins us today to present one of APSA's November articles of interest. The topic, gastric residuals in extremely premature infants, should we be checking them? Dr. Thenappan, uh, can you just, kind of before going into details about it, just let us know why you chose this article and what knowledge gap you thought it filled. As most of us pediatric surgeons have noticed, you know, evaluating gastric residuals has been sort of standard of care in most NICUs, probably for decades. But looking through the literature, there doesn't really seem to be much supporting evidence for it. Everybody sort of assumed we did it because it was a way to check for feeding intolerance, to having high gastric residuals is a presumably a risk for aspiration or ventilator associated pneumonia. And we thought it was maybe an early sign of necrotizing enterocolitis. But I don't know, is there any data to support that and should we actually be doing it? Can you give us the Cliff's Notes of Parker at all's article, effects of gastric residual evaluation on enteral intake in extremely pre-term infants, a randomized clinical trial. So, what the authors did is they, uh, basically performed a prospective randomized controlled trial in a level four NICU where they had about 140 patients that they split into half the group, they continued to check gastric residuals as they normally do, right before each feeding. And then the other group, they just stopped checking them. And what they did is then they followed these babies for six weeks and determined sort of how quickly they increased feeding, both on a daily basis as well as week by week. And then they looked at a number of secondary outcomes. And basically what they found is that the group in which they didn't check gastric residuals advanced feeds much quicker. They got to full feeds quicker as well, usually by five weeks. And they found on average that they got discharged from the NICU which is about eight days earlier, and there was no difference in their odds of developing necrotizing enterocolitis or ventilator associated pneumonia. So I'm a believer now. I just have a question. So, we are talking about otherwise healthy premature infants and we're doing it purely as an as an aid to advancing feeds. That's what we're saying we don't need to do. Specifically in this, they discount or removed any babies that had any GI conditions or cardiac disease or were post op. So these were just very low birth weight infants, might be on the ventilator have respiratory issues, but um, were otherwise fine. So my takeaway is this is just one more study that is so critical to challenge some of the dogma that we've been following without ever evaluating it. So I congratulate you for picking out this article and for the authors on writing this paper. So definitely a thought-provoking study. So thanks for joining us, Dr. Thenappan. Well, thank you. And stay tuned for the other November Article of Interest with our special guest, Dr. Robert Reade.