Dilemmas Surrounding Interpretation of Gastric Residuals in the NICU Setting

Providing enteral nutrition to preterm infants is a challenge because of the immaturity of the gastrointestinal tract. Clinicians often take a cautious approach to advancing enteral feedings because of concerns related to development of feeding intolerance or necrotizing enterocolitis. Gastric residuals provide a mechanism for monitoring feeding tolerance since they are easy to obtain and quantify. Despite the common practice of monitoring gastric residuals, there is a lack of agreement in determining when an obtained gastric residual becomes clinically significant. Furthermore, numerous factors can affect the characteristics of the gastric residual. A review of the literature demonstrates significant variability in defining a clinically significant gastric residual. Importantly, there is a lack of available evidence to support selected parameters. Recommendations for practice are discussed.