Re-feeding versus discarding gastric residuals in preterm infants less than 37 weeks of gestation - a randomized controlled trial

Early achievement of full enteral feeds in preterm infants has shown improved growth, and neurodevelopment and reduced the rate of sepsis. Gastric residual volumes are essential for digestion and gastrointestinal tract motility and maturation. Disposing of the partially digested milk and replacing it with fresh milk for the neonate might heighten the strain on the immature gut of preterm infants, consequently raising the likelihood of feed intolerance. It may create potentially creating an alkaline environment that increases the risk of NEC and late-onset sepsis. Conversely, reintroducing bile-stained or bloodstained gastric residuals during feeding may cause gastric irritation and vomiting and heighten the risk of infection, potentially resulting in NEC, sepsis, or both, when handling and reintroducing gastric contents. It usually depends on the nature and amount of the gastric aspirates. Available data from trials suggests that there is considerable variability in the approach to either refeeding or discarding gastric residual. Studies in neonates are limited. Given the lack of enough evidences from clinical trials, we aim to compare whether re-feeding of gastric residual volumes would reduce the time needed to achieve full enteral feeding in preterm infants and to determine whether the rate of death, duration of hospital stay, occurrence of NEC or feed intolerance would differ between the two groups.