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Abstract
Aim To observe signs of gastrointestinal dysmotility [gastric residual volume (GRV*), bile stained aspirates (BSA), abdominal distension (AD^), first passage of meconium (FPOM), and time to regular bowel habit (RBH)] whilst establishing enteral feeds. To examine how these signs were used to suggest diagnosis of NEC.
Methods From April–October 2013, intestinal motility data on all preterm infants ≤32 weeks was prospectively observed from birth-14 days old or until tolerating full enteral feeds (150 ml/kg/day) if sooner.
Results GRV, BSA and AD were common: (39/65 (60%), 37/65 (57%) and 17/65 (26%) respectively) and significantly prolonged time to full feeds: (median [IQR] (days) 13 [11–18] P = 0.0003, 13 [11–21] P = 0.0002 and 21 [12–28] P = 0.0001 respectively). Cox regression, adjusting for birth weight, showed each sign was a significant independent predictor of time to full feeds. Moreover, the number of signs in the first week following feed introduction predicted time to full feeds (Figure). Neither GRV nor BSA occurred more frequently in the NEC treatment group, but AD did (p = 0.002). Morphine had a stronger effect than gestational age on FPOM (P < 0.005) and RBH (P < 0.0005). Surprisingly, infants with functional dysmotility had significant earlier FPOM (day) than those who didn’t (2.0 vs. 3.3, P = 0.03).
Conclusion Functional intestinal dysmotility of the preterm infant is readily observed through GRV, BSA and AD soon after birth and should be considered, in the first two weeks of life, as possibly physiological before stopping enteral feeds or commencing NEC treatment.
