Routine Aspiration of Residual Gastric Contents in Very Low Birth Weight Infants

描述（由申请人提供）：对于早产极低出生体重（VLBW）婴儿，在出生后的最初几周内给予足够的肠内营养的重要性是众所周知的，对于促进最佳生长发育和减少早产相关并发症和医源性并发症是必要的。传统上，这些婴儿在每次喂养之前都要进行潜在残余胃内容物（RGC）的常规抽吸。体积增加被认为与喂养不耐受或坏死性小肠结肠炎的早期症状有关。在危重儿童和成人中，体积增加也被认为与呼吸道吸入胃分泌物有关。然而，没有确凿的证据表明这种做法可以改善护理或减少并发症，实际上可能会导致并发症，包括延迟实现完全肠内喂养。与延迟完全肠内喂养相关的潜在并发症包括肠外营养（PN）的使用增加，肠外营养相关肝病（PNALD），生长不良，需要中心静脉线（CVL）的时间更长，迟发性败血症（LOS）风险增加，住院时间延长，以及胃肠道（GI）完整性和功能紊乱。

DESCRIPTION (provided by applicant)::The importance of adequate enteral nutrition during the first few weeks following birth in premature very low birth weight (VLBW) infants is well known and necessary to facilitate optimal growth and development and reduce both premature birth-related and iatrogenic complications. Routine aspiration of potential residual gastric contents (RGC) has traditionally been performed prior to every feeding in these infants. Increased volumes have been thought to be related to feeding intolerance or an early symptom of necrotizing enterocolitis. In critically ill children and adults increased volumes have also bee thought to be associated with respiratory aspiration of gastric secretions. However, there is no conclusive evidence that this practice improves care or reduces complications and may actually contribute to complications including a delay in achievement of full enteral feedings. Potential complications related to delaying attainment of full enteral feedings include increased use of parenteral nutrition (PN), parenteral nutrition associated liver disease (PNALD), poor growth, more hours requiring a central venous line (CVL), increased risk of late onset sepsis (LOS), prolonged hospitalization, as well as disturbances in gastrointestinal (GI) integrity and function. The overall objective of this 4-year study is to determine whether omission of routine aspiration of potential RGC improves nutritional outcomes of VLBW premature infants. The proposed study will follow a prospective cohort (N = 120) of racially and economically diverse premature VLBW infants for 6 weeks following birth. Aim 1 will determine the risks and benefits of aspirating RGC and the clinical benefits of omitting aspiration of RGC prior to enteral feedings on nutritional outcomes of premature VLBW infants including weekly enteral intake, time to reach full enteral feedings, growth indices, hours of TPN, incidence of PNALD, hours with a CVL, incidence of LOS, and length of stay. For Aim 2, the effect of routine RGC aspiration on GI mucosal bleeding and inflammation will be determined through measurement of blood and calprotectin in the stool. The effect of aspiration of RGC on GI function will be measured using serum levels of the peptides gastrin and motilin in Aim 3. All enrolled infants will receive the same care with one exception. Those randomly assigned to the Control Group will continue to have routine aspiration of potential RGC prior to every feeding and those in the Experimental Group will not. Outcomes measures will be monitored over 6 weeks. Results are expected to fill an important gap in research regarding the necessity of aspirating RGC prior to feeding in premature VLBW infants, whether aspiration of RGC influences short and long term outcomes and whether routine aspiration of RGC is detrimental to premature VLBW infants.