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Neonatology
Original research
Gastric residual volume measurement in British neonatal intensive care units: a survey of practice
  1. Jon Dorling1,
  2. Lyvonne Tume2,
  3. Barbara Arch3,
  4. Kerry Woolfall4,
  5. Lynne Latten5,
  6. Louise Roper4,
  7. Elizabeth Deja4,
  8. Nazima Pathan6,
  9. Helen Eccleson3,
  10. Helen Hickey3,
  11. Michaela Brown3,
  12. Anne Beissel7,
  13. Izabela Andrzejewska8,
  14. Frederic Valla9,
  15. Chris Gale10
  1. 1Division of Neonatal-Perinatal Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  2. 2Child Health, University of Salford, Salford, Greater Manchester, UK
  3. 3Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, Merseyside, UK
  4. 4Health Services Research, University of Liverpool, Liverpool, Merseyside, UK
  5. 5Dietetics, Alder Hey Children's Hospital, Liverpool, UK
  6. 6Paediatrics, University of Cambridge, Cambridge, Cambridgeshire, UK
  7. 7Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Lyon-Bron, France
  8. 8Neonatal Unit, Chelsea and Westminster Healthcare NHS Trust, London, UK
  9. 9Service de Réanimation Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Lyon, France
  10. 10Academic Neonatal Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Jon Dorling; Jon.Dorling{at}iwk.nshealth.ca

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.

  • measurement
  • neonatology
  • gastroenterology
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjpo-2019-000601

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    Footnotes

    • Twitter @DrCGale

    • Contributors JD and LT planned the study and incorporated comments from all members on the study design, conduct, interpretation and reporting of the work. BA analysed the quantitative data. KW, ED and LR analysed the open answer responses. LT and JD analysed the guideline content. JD is responsible for the overall content as guarantor.

    • Funding This work was supported by NIHR HTA programme as part of a larger NIHR HTA-funded feasibility study (grant number 16/94/02).

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • 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.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for the study was provided by the University of the West of England (Reference: HAS.18.04.144).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.