Gavage Feed Volume Determines the Gastric Emptying Rate in Preterm Infants

Objective: Feeding intolerance, manifesting as increased gastric residual, is a common finding in preterm neonates. Little is known about the regulation of gastric emptying early in life and the extent to which this plays a role in the preterm infants' feeding tolerance. The goal of this study was to evaluate clinically stable 28- to 32-week gestation neonates during the first 4 weeks of life and noninvasively determine their gastric emptying rate. Study design: Ultrasound measurements of gastric milk content volume were obtained from 25 neonates immediately after, 30 and/or 60 minutes following routine gavage feeds. The content emptying rate was calculated from the gastric volume data. Results: Gastric emptying rate was not postnatal age-dependent, was significantly higher at 30 minutes, whenever compared with 60-minute postfeed and directly proportional to the feed volume. At any postnatal age, the gastric emptying rate was at least 6-fold greater, when comparing the lowest and highest average stomach content volumes. Conclusions: The gastric emptying rate of preterm infants is content volume-dependent and unrelated to the postnatal age. Given the present findings, further investigation on the gastric residual of preterm infants receiving larger than currently administered feed volumes at the initiation of enteral nutrition, is warranted. Address correspondence and reprint requests to Jaques Belik, MD, Physiology & Experimental Medicine Program, Department of Paediatrics and Physiology, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, University of Toronto, 686 Bay Street, 9th Floor, Room 09.9713, Toronto, ON M5G 0A4, Canada (e-mail: jaques.belik@sickkids.ca) Received 1 September, 2017 Accepted 6 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Funding sources: This study was supported by a grant from the Canadian Institutes of Health Research to J.B. (MOP 133664) and Brazilian Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; SWE 202940/2015-2) for C.H.F.F. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript. The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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