Routine Gastric Residual Volume Measurement in Preterm Infants: Impact on Time to Full Enteral Feeding

Abstract

Introduction: Gastric residual volume (GRV) measurement before each feed is standard practice to detect feeding intolerance in preterm infants. However, evidence suggests GRV monitoring may delay feeding advancement without reducing necrotizing enterocolitis (NEC) risk.

Methods: We searched PubMed, Cochrane, and Scopus for RCTs comparing GRV monitoring versus no GRV monitoring (or visual inspection only) in preterm infants <34 weeks receiving enteral feeds. Primary outcome: time to reach full enteral feeds (≥140 mL/kg/day). Secondary: NEC (Bell stage ≥2), days of parenteral nutrition, vomiting episodes. Meta-analysis used inverse variance.

Results: Six RCTs (n=1,203 infants) met inclusion. Absence of routine GRV measurement significantly reduced time to full feeds (mean difference –2.8 days, 95% CI –4.1 to –1.5, p<0.001). Parenteral nutrition days decreased by 2.1 days. NEC incidence was unchanged (RR 0.94, 95% CI 0.58–1.52). Vomiting episodes did not differ. In three studies, GRV thresholds (>50% of previous feed volume) triggered feeding cessation in 22% of GRV-monitored infants vs. 4% in non-monitored (p<0.001).

Discussion: Routine GRV measurement delays feeding advancement due to unnecessary feeding cessations for residuals that do not predict NEC. The practice appears to be a self-fulfilling prophecy of feeding intolerance. Limitations include lack of blinding and variable GRV thresholds.

Conclusions: Routine gastric residual volume measurement does not prevent NEC and prolongs time to full enteral feeds in preterm infants. Discontinuing routine GRV monitoring is safe and promotes faster nutritional autonomy.