A Feasibility Study of No Routine Gastric Residual Volume measurement in mechanically ventilated Infants and Children

This study aims to identify the benefits of regularly measuring the amount of fluid in a child or baby's stomach (GRV) to help decide if a child is ready to have the feed into their stomach. This fluid is measured by sucking it out via a tube already into the child's stomach. This is a very common practice in intensive care units in the UK, but it is unclear if this practice is helpful. One problem we know about is that it can delay the child getting the full amount of feed they need. Although there is research evidence from adults in intensive that not measuring it is safe, and they got more calories, we do not know whether not measuring GRV in babies and children could cause harm or be beneficial. Before a full trial can be undertaken, preparatory work is needed and this proposed study aims to do this. The research is important because measuring GRV may prevent problems from overfeeding when the bowel cannot cope with milk and is not absorbing feeds. In children, the main problem is vomiting of the stomach contents, and breathing this fluid into the lungs. The main worry in babies under a month old, is a very serious infection of the bowel (necrotising enterocolitis). This nursing practice is heavily based on tradition and perceived risk, but benefits have not been proven and it may be harmful as feeds are often stopped, reducing the calories that babies and children receive. If measuring GRV is not beneficial, then there will be savings in time and cost for staff and potential benefits from reaching nutritional dietary intakes sooner. Ensuring that babies and children have adequate feed is vital in intensive care, and not doing so slows recovery. Adequate energy supply to the organs, especially the brain and heart is needed in severe illness, and recovery requires enough calories to help heal damaged tissues. We know that inadequate nutrition is common in babies and children in intensive care units and measuring GRV may be contributing to this. All children's and baby's intensive care units in the UK measure GRV routinely, unlike in other countries like France. Before changing practice in the UK, it is necessary to undertake a study to determine the benefits and safety of not measuring GRV.