Gastric residual volume measurement in British neonatal intensive care units: A survey of practice

Jon Dorling; Lyvonne Tume; Barbara Arch; Kerry Woolfall; Lynne Latten; Louise Roper; Elizabeth Deja; Nazima Pathan; Helen Eccleson; Helen Hickey; Michaela Brown; Anne Beissel; Izabela Andrzejewska; Frederic Valla; Chris Gale

doi:10.1136/bmjpo-2019-000601

Gastric residual volume measurement in British neonatal intensive care units: A survey of practice

Jon Dorling, Lyvonne Tume, Barbara Arch, Kerry Woolfall, Lynne Latten, Louise Roper, Elizabeth Deja, Nazima Pathan, Helen Eccleson, Helen Hickey, Michaela Brown, Anne Beissel, Izabela Andrzejewska, Frederic Valla, Chris Gale

Medicine

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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.

Original language	English
Article number	e000601
Journal	BMJ Paediatrics Open
Volume	4
Issue number	1
DOIs	https://doi.org/10.1136/bmjpo-2019-000601
Publication status	Published - Aug 7 2020

Bibliographical note

Funding Information:
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.

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

Publisher Copyright:
©

ASJC Scopus Subject Areas

Pediatrics, Perinatology, and Child Health

PubMed: MeSH publication types

Journal Article

Access to Document

10.1136/bmjpo-2019-000601

Cite this

Dorling, J., Tume, L., Arch, B., Woolfall, K., Latten, L., Roper, L., Deja, E., Pathan, N., Eccleson, H., Hickey, H., Brown, M., Beissel, A., Andrzejewska, I., Valla, F., & Gale, C. (2020). Gastric residual volume measurement in British neonatal intensive care units: A survey of practice. BMJ Paediatrics Open, 4(1), Article e000601. https://doi.org/10.1136/bmjpo-2019-000601

@article{89e3a249336b47d0935f44083114eeea,

title = "Gastric residual volume measurement in British neonatal intensive care units: A survey of practice",

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.",

author = "Jon Dorling and Lyvonne Tume and Barbara Arch and Kerry Woolfall and Lynne Latten and Louise Roper and Elizabeth Deja and Nazima Pathan and Helen Eccleson and Helen Hickey and Michaela Brown and Anne Beissel and Izabela Andrzejewska and Frederic Valla and Chris Gale",

note = "Funding Information: 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. Funding Information: Funding This work was supported by NIHR HTA programme as part of a larger NIHR HTA-funded feasibility study (grant number 16/94/02). Publisher Copyright: {\textcopyright} ",

year = "2020",

month = aug,

day = "7",

doi = "10.1136/bmjpo-2019-000601",

language = "English",

volume = "4",

journal = "BMJ Paediatrics Open",

issn = "2399-9772",

publisher = "BMJ Publishing Group",

number = "1",

}

TY - JOUR

T1 - Gastric residual volume measurement in British neonatal intensive care units

T2 - A survey of practice

AU - Dorling, Jon

AU - Tume, Lyvonne

AU - Arch, Barbara

AU - Woolfall, Kerry

AU - Latten, Lynne

AU - Roper, Louise

AU - Deja, Elizabeth

AU - Pathan, Nazima

AU - Eccleson, Helen

AU - Hickey, Helen

AU - Brown, Michaela

AU - Beissel, Anne

AU - Andrzejewska, Izabela

AU - Valla, Frederic

AU - Gale, Chris

N1 - Funding Information: 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. Funding Information: Funding This work was supported by NIHR HTA programme as part of a larger NIHR HTA-funded feasibility study (grant number 16/94/02). Publisher Copyright: ©

PY - 2020/8/7

Y1 - 2020/8/7

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85090150463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85090150463&partnerID=8YFLogxK

U2 - 10.1136/bmjpo-2019-000601

DO - 10.1136/bmjpo-2019-000601

M3 - Article

C2 - 32821858

AN - SCOPUS:85090150463

SN - 2399-9772

VL - 4

JO - BMJ Paediatrics Open

JF - BMJ Paediatrics Open

IS - 1

M1 - e000601

ER -

Gastric residual volume measurement in British neonatal intensive care units: A survey of practice

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

Access to Document

Other files and links

Fingerprint

Cite this