Gastric residual volume measurement in British neonatal intensive care units: a survey of practice
Gastric residual volume measurement in British neonatal intensive care units: a survey of practice
Objective: despite little evidence, the practice of routine gastric residual volume (GRV) measurement to guide enteral feeding in neonatal units is widespread. Due to increased interest in this practice, and to examine trial feasibility, we aimed to determine enteral feeding and GRV measurement practices in British neonatal units.
Design and setting: an online survey was distributed via email to all neonatal units and networks in England, Scotland and Wales. A clinical nurse, senior doctor and dietitian were invited to collaboratively complete the survey and submit a copy of relevant guidelines.
Results: 95/184 (51.6%) approached units completed the survey, 81/95 (85.3%) reported having feeding guidelines and 28 guidelines were submitted for review. The majority of units used intermittent (90/95) gastric feeds as their primary feeding method. 42/95 units reported specific guidance for measuring and interpreting GRV. 20/90 units measured GRV before every feed, 39/90 at regular time intervals (most commonly four to six hourly 35/39) and 26/90 when felt to be clinically indicated. Most units reported uncertainty on the utility of aspirate volume for guiding feeding decisions; 13/90 reported that aspirate volume affected decisions 'very much'. In contrast, aspirate colour was reported to affect decisions 'very much' by 37/90 of responding units. Almost half, 44/90, routinely returned aspirates to the stomach.
Conclusions: routine GRV measurement is part of standard practice in British neonatal units, although there was inconsistency in how frequently to measure or how to interpret the aspirate. Volume was considered less important than colour of the aspirate.
gastroenterology, measurement, neonatology
Dorling, Jon
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Tume, Lyvonne
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Arch, Barbara
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Woolfall, Kerry
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Latten, Lynne
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Roper, Louise
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Deja, Elizabeth
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Pathan, Nazima
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Eccleson, Helen
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Hickey, Helen
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Brown, Michaela
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Beissel, Anne
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Andrzejewska, Izabela
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Valla, Frederic
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Gale, Chris
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Dorling, Jon
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Tume, Lyvonne
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Arch, Barbara
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Woolfall, Kerry
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Latten, Lynne
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Roper, Louise
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Deja, Elizabeth
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Pathan, Nazima
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Eccleson, Helen
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Hickey, Helen
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Brown, Michaela
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Beissel, Anne
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Andrzejewska, Izabela
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Valla, Frederic
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Gale, Chris
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Dorling, Jon, Tume, Lyvonne, Arch, Barbara, Woolfall, Kerry, Latten, Lynne, Roper, Louise, Deja, Elizabeth, Pathan, Nazima, Eccleson, Helen, Hickey, Helen, Brown, Michaela, Beissel, Anne, Andrzejewska, Izabela, Valla, Frederic and Gale, Chris
(2020)
Gastric residual volume measurement in British neonatal intensive care units: a survey of practice.
BMJ Paediatrics Open, 4 (1), [e000601].
(doi:10.1136/bmjpo-2019-000601).
Abstract
Objective: despite little evidence, the practice of routine gastric residual volume (GRV) measurement to guide enteral feeding in neonatal units is widespread. Due to increased interest in this practice, and to examine trial feasibility, we aimed to determine enteral feeding and GRV measurement practices in British neonatal units.
Design and setting: an online survey was distributed via email to all neonatal units and networks in England, Scotland and Wales. A clinical nurse, senior doctor and dietitian were invited to collaboratively complete the survey and submit a copy of relevant guidelines.
Results: 95/184 (51.6%) approached units completed the survey, 81/95 (85.3%) reported having feeding guidelines and 28 guidelines were submitted for review. The majority of units used intermittent (90/95) gastric feeds as their primary feeding method. 42/95 units reported specific guidance for measuring and interpreting GRV. 20/90 units measured GRV before every feed, 39/90 at regular time intervals (most commonly four to six hourly 35/39) and 26/90 when felt to be clinically indicated. Most units reported uncertainty on the utility of aspirate volume for guiding feeding decisions; 13/90 reported that aspirate volume affected decisions 'very much'. In contrast, aspirate colour was reported to affect decisions 'very much' by 37/90 of responding units. Almost half, 44/90, routinely returned aspirates to the stomach.
Conclusions: routine GRV measurement is part of standard practice in British neonatal units, although there was inconsistency in how frequently to measure or how to interpret the aspirate. Volume was considered less important than colour of the aspirate.
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Accepted/In Press date: 11 June 2020
e-pub ahead of print date: 7 August 2020
Additional Information:
Funding Information:
Competing interests JD reports grants from National Institute for Health Research (NIHR), during the conduct of the study; grants from NIHR, grants from Nutrinia, outside the submitted work. LT reports grant from NIHR, during the conduct of the study. ED reports grants from NIHR Health Technology Assessment (HTA) programme during the conduct of the study. HE reports grants from NIHR HTA during the conduct of the study. HH reports this grant from NIHR HTA, during the conduct of the study. MB reports grants from NIHR HTA during the conduct of the study. CG reports grants from NIHR, during the conduct of the study; grants from NIHR, grants from Medical Research Foundation, grants from Mason Medical Research Foundation, grants and personal fees from Chiesi Pharmaceuticals, grants from Rosetrees Foundation, grants from Canadian Institute for Health Research, outside the submitted work. FV reports personal fees from Baxter, personal fees from Nutricia, outside the submitted work. LT reports grants from NIHR during the conduct of the study.
Funding This work was supported by NIHR HTA programme as part of a larger NIHR HTA-funded feasibility study (grant number 16/94/02).
Keywords:
gastroenterology, measurement, neonatology
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Local EPrints ID: 484998
URI: http://eprints.soton.ac.uk/id/eprint/484998
PURE UUID: 3734d95d-bb42-4248-9ebc-7495dd3e8db4
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Date deposited: 27 Nov 2023 18:38
Last modified: 18 Mar 2024 04:16
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Contributors
Author:
Jon Dorling
Author:
Lyvonne Tume
Author:
Barbara Arch
Author:
Kerry Woolfall
Author:
Lynne Latten
Author:
Louise Roper
Author:
Elizabeth Deja
Author:
Nazima Pathan
Author:
Helen Eccleson
Author:
Helen Hickey
Author:
Michaela Brown
Author:
Anne Beissel
Author:
Izabela Andrzejewska
Author:
Frederic Valla
Author:
Chris Gale
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