264 - Influence of Routine Gastric Residual ASSessment in Preterm Neonates on Time Taken to Reach Full Enteral Feeding (The GRASS Trial) – A Randomised Control Trial

Poster Number: 264
Publication Number: 264.131

Aoife Branagan, Coombe Woman and Infants University Hospital, Dublin, Dublin, Ireland; Claire Murphy, Royal college of surgeons in ireland, Dublin, Dublin, Ireland; Anne O'Sullivan, Coombe Woman and Infants University Hospital, Dublin, Dublin, Ireland; Iva Bodnarova, Charles University, 1st Faculty of Medicine, Prague, Prague, Hlavni mesto Praha, Czech Republic; Simona Feyereislova, Institute for the Care of Mother and Child, Zdice, Stredocesky kraj, Czech Republic; Ivan Berka, Institute for the Care of Mother and Child, Prague, Hlavni mesto Praha, Czech Republic; Jan M. Miletin, Coombe Women & Infants University Hospital, Dublin, Dublin, Ireland; Zbynek Stranak, Institute for the Care of Mother and Child, Prague, Czechia, Hovorcovice, Stredocesky kraj, Czech Republic

Background: Gastric residual measurement, the aspiration and evaluation of stomach contents, is routinely performed prior to feeding preterm infants and used as a symptom of feed intolerance. Historically large residuals have been seen as an indication of necrotising enterocolitis. Residual measurement may lead to a diagnosis of feed intolerance, leading to withholding feeds and may delay achievement of full feeds.

Objective: Our aim was to investigate if the exclusion of routine checks of gastric residuals would have an impact on the time taken to achieve full enteral feeding in preterm infants. 

Design/Methods: An international multicentre randomised controlled trial was carried out in two level III NICUs. Clinically stable infants between 26+0 and 30+6 weeks gestation, appropriate for gestational age, with birth weight < 1.5kg were eligible for inclusion. Infants with inotropic support, highly suspected early-onset sepsis and congenital malformations were excluded.
Infants were randomized to intervention arm (no monitoring of gastric aspirates) or control arm (routine care), stratified by centre and gestation. Primary outcome was achievement of full enteral feeds (defined as 100ml/kg/day) by day 5 of life. Secondary outcomes were withholding of feeds, duration of central access and parenteral nutrition, incidence of complications of prematurity. We hypothesised that 90% of infants in the intervention arm will achieve our primary outcome compared to 65% in the control arm.

Results: Ninety-five infants were recruited (October 2017 - July 2021). Seven infants were excluded. Eighty-eight infants were included in an intention to treat analysis, 45 in intervention arm and 43 in control arm with no obvious imbalances in baseline characteristics.
Eight infants crossed to the control arm as per safety strategy defined in the protocol (need to withhold enteral feeds for >6hrs).
Regarding the primary outcome, 33 (73.3%) infants in the intervention group and 32 (74.4%) infants in the control group reached full feeds by day 5 of life (p=0.91). Median time to full feeds was 111 hours (IQR 17) in intervention arm compared to 111 hours (IQR 24) in control arm (p = 0.99). There were no significant differences in any of the predefined secondary outcomes.Conclusion(s): There was no difference in time to attain full enteral feeds in premature infants when gastric residuals were not monitored. In the absence of clinical benefit to routine monitoring, it may be appropriate to only monitor residuals when clinical concern arises in this group of patients.