Gastric Residuals In The NICU; A Systematic Review

For premature infants in the neonatal intensive care unit (NICU), it is common practice to check gastric residuals before each enteral feeding due to immaturity of the gastrointestinal (GI) tract. Gastric residuals are monitored to assess for developing feeding intolerance or necrotizing enterocolitis. For those NICUs who practice routine monitoring, there is variability in defining what specific characteristics are critical when deciding whether the obtained gastric residual is clinically significant. Decisions are typically based on color, consistency, and volume of the gastric residual in conjunction with the infant’s abdominal assessment. Interpretation of the gastric residual color is subjective in nature compared to other assessment characteristics. Enteral feedings may be withheld based on the findings of this assessment and prolong the reliance on parenteral nutrition. The purpose of this systematic review was twofold: (1) to determine when the color of a gastric residual is deemed clinically significant in the NICU and (2) to highlight the subjective nature of determining gastric residual color. Researchers have demonstrated that when NICU healthcare workers are asked to identify bilious gastric aspirates from simulated gastric residuals, colors such as dark green and black are consistently selected but, there is significant variability when selecting among gradations of yellow and green. Shade of green and yellow are the most problematic. A review of standardized feeding protocols that include gastric residual color demonstrates variability in defining a clinically concerning residual. These protocols contain descriptive adjectives such as “bilious,” “blood-tinged,” “blood-stained,” and “hemorrhagic.” However, there is a lack of agreement among the published protocols as to whether a “bilious” gastric residual is clinically concerning. Taken together, there is a lack of consensus when using color to define a clinically significant gastric residual. For NICUs that include assessment of gastric residuals as part of their standard of care, it is critical that an evidence-based feeding protocol is implemented that includes an algorithm for the assessment of gastric residuals. This will minimize individual subjectivity among NICU healthcare providers and maximize enteral feedings in premature infants.A five-year embargo was granted for this item.Academic Major: Nursin