Routine prefeed gastric aspiration in preterm infants: a systematic review and meta-analysis
Despite lack of evidence, the practice of routine prefeed gastric residue aspiration before the next feed is common. Recent studies suggest that this practice might be even harmful. Therefore, we aimed to evaluate the effect of avoiding routine prefeed gastric residue aspiration as compared to routi...
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Veröffentlicht in: | European journal of pediatrics 2021-08, Vol.180 (8), p.2367-2377 |
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description | Despite lack of evidence, the practice of routine prefeed gastric residue aspiration before the next feed is common. Recent studies suggest that this practice might be even harmful. Therefore, we aimed to evaluate the effect of avoiding routine prefeed gastric residue aspiration as compared to routine aspiration, on various clinical outcomes in preterm infants. We searched five different electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library) until March 8, 2021. Only randomized controlled trials comparing the practice of routine prefeed gastric aspiration with no routine aspiration in preterm infants were considered eligible. The random-effects meta-analysis was done using RevMan 5.3 software. Of the 894 unique records identified by our search, we included 6 studies (451 participants) in the review. There was no significant difference in the incidence of necrotizing enterocolitis (RR 0.80; 95% CI 0.31 to 2.08; 421 participants in 5 trials). Avoiding routine prefeed aspiration was associated with achieving full enteral feeds earlier (MD − 3.19 days, 95% CI − 4.22 to − 2.16), shorter duration of hospitalization (MD − 5.32 days; 95% CI − 10.25 to − 0.38), and lower incidence of late-onset sepsis (RR 0.77; 95% CI 0.60 to 0.99). Time to regain birth weight, days of total parenteral nutrition or central venous line usage, culture-positive sepsis, and all-cause mortality did not differ between the two groups.
Conclusion
: In the absence of other signs of feed intolerance, routine prefeed gastric residue aspiration should be avoided in preterm infants.
Prospero registration number
: CRD42020197657
What is Known:
• Though, routine prefeed aspiration before next feed is a common practice in preterm gavage-fed infants.
• Recent study suggests that the omission of routine gastric residual evaluation led to improved weight gain and earlier hospital discharge.
What is New:
• Low- to moderate-quality evidence suggest that avoiding routine prefeed gastric residue monitoring helps in the reduction of late-onset sepsis, achieving full enteral feeds earlier, and earlier discharge from the hospital.
• Abandoning the practice of routine prefeed aspiration in absence of other signs of feed intolerance in preterm low birthweight neonates is safe. |
doi_str_mv | 10.1007/s00431-021-04122-y |
format | Article |
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Conclusion
: In the absence of other signs of feed intolerance, routine prefeed gastric residue aspiration should be avoided in preterm infants.
Prospero registration number
: CRD42020197657
What is Known:
• Though, routine prefeed aspiration before next feed is a common practice in preterm gavage-fed infants.
• Recent study suggests that the omission of routine gastric residual evaluation led to improved weight gain and earlier hospital discharge.
What is New:
• Low- to moderate-quality evidence suggest that avoiding routine prefeed gastric residue monitoring helps in the reduction of late-onset sepsis, achieving full enteral feeds earlier, and earlier discharge from the hospital.
• Abandoning the practice of routine prefeed aspiration in absence of other signs of feed intolerance in preterm low birthweight neonates is safe.</description><identifier>ISSN: 0340-6199</identifier><identifier>EISSN: 1432-1076</identifier><identifier>DOI: 10.1007/s00431-021-04122-y</identifier><identifier>PMID: 34018044</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Birth Weight ; Clinical trials ; Enteral Nutrition ; Enterocolitis ; Enterocolitis, Necrotizing ; Gastrointestinal diseases ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infants ; Intolerance ; Medicine ; Medicine & Public Health ; Meta-analysis ; Necrosis ; Necrotizing enterocolitis ; Neonates ; Newborn babies ; Parenteral nutrition ; Pediatrics ; Premature babies ; Review ; Sepsis</subject><ispartof>European journal of pediatrics, 2021-08, Vol.180 (8), p.2367-2377</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-3e24e5a740777b25f90decc38249a0ae8958cee7c8482f422889dcd2d62bf6373</citedby><cites>FETCH-LOGICAL-c375t-3e24e5a740777b25f90decc38249a0ae8958cee7c8482f422889dcd2d62bf6373</cites><orcidid>0000-0003-4742-8787</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00431-021-04122-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00431-021-04122-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34018044$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumar, Jogender</creatorcontrib><creatorcontrib>Meena, Jitendra</creatorcontrib><creatorcontrib>Mittal, Piyush</creatorcontrib><creatorcontrib>Shankar, Jeeva</creatorcontrib><creatorcontrib>Kumar, Praveen</creatorcontrib><creatorcontrib>Shenoi, Arvind</creatorcontrib><title>Routine prefeed gastric aspiration in preterm infants: a systematic review and meta-analysis</title><title>European journal of pediatrics</title><addtitle>Eur J Pediatr</addtitle><addtitle>Eur J Pediatr</addtitle><description>Despite lack of evidence, the practice of routine prefeed gastric residue aspiration before the next feed is common. Recent studies suggest that this practice might be even harmful. Therefore, we aimed to evaluate the effect of avoiding routine prefeed gastric residue aspiration as compared to routine aspiration, on various clinical outcomes in preterm infants. We searched five different electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library) until March 8, 2021. Only randomized controlled trials comparing the practice of routine prefeed gastric aspiration with no routine aspiration in preterm infants were considered eligible. The random-effects meta-analysis was done using RevMan 5.3 software. Of the 894 unique records identified by our search, we included 6 studies (451 participants) in the review. There was no significant difference in the incidence of necrotizing enterocolitis (RR 0.80; 95% CI 0.31 to 2.08; 421 participants in 5 trials). Avoiding routine prefeed aspiration was associated with achieving full enteral feeds earlier (MD − 3.19 days, 95% CI − 4.22 to − 2.16), shorter duration of hospitalization (MD − 5.32 days; 95% CI − 10.25 to − 0.38), and lower incidence of late-onset sepsis (RR 0.77; 95% CI 0.60 to 0.99). Time to regain birth weight, days of total parenteral nutrition or central venous line usage, culture-positive sepsis, and all-cause mortality did not differ between the two groups.
Conclusion
: In the absence of other signs of feed intolerance, routine prefeed gastric residue aspiration should be avoided in preterm infants.
Prospero registration number
: CRD42020197657
What is Known:
• Though, routine prefeed aspiration before next feed is a common practice in preterm gavage-fed infants.
• Recent study suggests that the omission of routine gastric residual evaluation led to improved weight gain and earlier hospital discharge.
What is New:
• Low- to moderate-quality evidence suggest that avoiding routine prefeed gastric residue monitoring helps in the reduction of late-onset sepsis, achieving full enteral feeds earlier, and earlier discharge from the hospital.
• Abandoning the practice of routine prefeed aspiration in absence of other signs of feed intolerance in preterm low birthweight neonates is safe.</description><subject>Birth Weight</subject><subject>Clinical trials</subject><subject>Enteral Nutrition</subject><subject>Enterocolitis</subject><subject>Enterocolitis, Necrotizing</subject><subject>Gastrointestinal diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Low Birth Weight</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Infants</subject><subject>Intolerance</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Necrosis</subject><subject>Necrotizing enterocolitis</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Parenteral nutrition</subject><subject>Pediatrics</subject><subject>Premature babies</subject><subject>Review</subject><subject>Sepsis</subject><issn>0340-6199</issn><issn>1432-1076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1LHTEUhkOp1Ntr_0AXJdCNm6n5mknGXRH7AYIguhNCbuaMRObLnExl_r2ZXqvQhYuQkPO8b8JDyGfOvnHG9AkypiQvmMhLcSGK5R3ZcCVFwZmu3pMNk4oVFa_rQ_IR8Z7lUM3NB3KY77lhSm3I7dU4pzAAnSK0AA29c5hi8NThFKJLYRxoGNZpgtjnY-uGhKfUUVwwQZ8JTyP8CfBI3dDQHpIr3OC6BQMekYPWdQifnvctuflxfn32q7i4_Pn77PtF4aUuUyFBKCidVkxrvRNlW7MGvJdGqNoxB6YujQfQ3igjWiWEMXXjG9FUYtdWUsstOd73TnF8mAGT7QN66Do3wDijFaXMenhdrujX_9D7cY75vytVCm5KmektEXvKxxExm7FTDL2Li-XMru7t3r3N7u1f93bJoS_P1fOuh-Yl8k92BuQewDwa7iC-vv1G7RPds4-O</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Kumar, Jogender</creator><creator>Meena, Jitendra</creator><creator>Mittal, Piyush</creator><creator>Shankar, Jeeva</creator><creator>Kumar, Praveen</creator><creator>Shenoi, Arvind</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4742-8787</orcidid></search><sort><creationdate>20210801</creationdate><title>Routine prefeed gastric aspiration in preterm infants: a systematic review and meta-analysis</title><author>Kumar, Jogender ; Meena, Jitendra ; Mittal, Piyush ; Shankar, Jeeva ; Kumar, Praveen ; Shenoi, Arvind</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-3e24e5a740777b25f90decc38249a0ae8958cee7c8482f422889dcd2d62bf6373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Birth Weight</topic><topic>Clinical trials</topic><topic>Enteral Nutrition</topic><topic>Enterocolitis</topic><topic>Enterocolitis, Necrotizing</topic><topic>Gastrointestinal diseases</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Low Birth Weight</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Infants</topic><topic>Intolerance</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Necrosis</topic><topic>Necrotizing enterocolitis</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Parenteral nutrition</topic><topic>Pediatrics</topic><topic>Premature babies</topic><topic>Review</topic><topic>Sepsis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kumar, Jogender</creatorcontrib><creatorcontrib>Meena, Jitendra</creatorcontrib><creatorcontrib>Mittal, Piyush</creatorcontrib><creatorcontrib>Shankar, Jeeva</creatorcontrib><creatorcontrib>Kumar, Praveen</creatorcontrib><creatorcontrib>Shenoi, Arvind</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kumar, Jogender</au><au>Meena, Jitendra</au><au>Mittal, Piyush</au><au>Shankar, Jeeva</au><au>Kumar, Praveen</au><au>Shenoi, Arvind</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Routine prefeed gastric aspiration in preterm infants: a systematic review and meta-analysis</atitle><jtitle>European journal of pediatrics</jtitle><stitle>Eur J Pediatr</stitle><addtitle>Eur J Pediatr</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>180</volume><issue>8</issue><spage>2367</spage><epage>2377</epage><pages>2367-2377</pages><issn>0340-6199</issn><eissn>1432-1076</eissn><abstract>Despite lack of evidence, the practice of routine prefeed gastric residue aspiration before the next feed is common. Recent studies suggest that this practice might be even harmful. Therefore, we aimed to evaluate the effect of avoiding routine prefeed gastric residue aspiration as compared to routine aspiration, on various clinical outcomes in preterm infants. We searched five different electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library) until March 8, 2021. Only randomized controlled trials comparing the practice of routine prefeed gastric aspiration with no routine aspiration in preterm infants were considered eligible. The random-effects meta-analysis was done using RevMan 5.3 software. Of the 894 unique records identified by our search, we included 6 studies (451 participants) in the review. There was no significant difference in the incidence of necrotizing enterocolitis (RR 0.80; 95% CI 0.31 to 2.08; 421 participants in 5 trials). Avoiding routine prefeed aspiration was associated with achieving full enteral feeds earlier (MD − 3.19 days, 95% CI − 4.22 to − 2.16), shorter duration of hospitalization (MD − 5.32 days; 95% CI − 10.25 to − 0.38), and lower incidence of late-onset sepsis (RR 0.77; 95% CI 0.60 to 0.99). Time to regain birth weight, days of total parenteral nutrition or central venous line usage, culture-positive sepsis, and all-cause mortality did not differ between the two groups.
Conclusion
: In the absence of other signs of feed intolerance, routine prefeed gastric residue aspiration should be avoided in preterm infants.
Prospero registration number
: CRD42020197657
What is Known:
• Though, routine prefeed aspiration before next feed is a common practice in preterm gavage-fed infants.
• Recent study suggests that the omission of routine gastric residual evaluation led to improved weight gain and earlier hospital discharge.
What is New:
• Low- to moderate-quality evidence suggest that avoiding routine prefeed gastric residue monitoring helps in the reduction of late-onset sepsis, achieving full enteral feeds earlier, and earlier discharge from the hospital.
• Abandoning the practice of routine prefeed aspiration in absence of other signs of feed intolerance in preterm low birthweight neonates is safe.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34018044</pmid><doi>10.1007/s00431-021-04122-y</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4742-8787</orcidid></addata></record> |
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subjects | Birth Weight Clinical trials Enteral Nutrition Enterocolitis Enterocolitis, Necrotizing Gastrointestinal diseases Humans Infant Infant, Low Birth Weight Infant, Newborn Infant, Premature Infants Intolerance Medicine Medicine & Public Health Meta-analysis Necrosis Necrotizing enterocolitis Neonates Newborn babies Parenteral nutrition Pediatrics Premature babies Review Sepsis |
title | Routine prefeed gastric aspiration in preterm infants: a systematic review and meta-analysis |
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