Feeding intolerance

The bedside nurse will assess the baby’s abdominal exam and check residuals (if gavage fed) before every feed or every 3-4 hours if COG fed. The nursing staff should notify a physician for any of the following signs of feeding intolerance:

• excessive gastric residuals

• > 2x the hourly rate on COG feeds

• > ½ the feeding volume on bolus gavage feeds

• bilious or bloody gastric aspirates

• vomiting

• visible or palpable loops of bowel on abdominal exam

• a firm or distended abdomen

• heme-positive or grossly bloody stools

• diarrhea

Infants with feeding intolerance should be closely evaluated by the physician.

Infants with bilious residuals, a firm, distended abdomen, and/or grossly bloody stools have findings most concerning for symptoms of NEC, ileus, or abdominal catastrophe. These infants should be made NPO, a KUB obtained, and further work-up performed as clinically indicated.

Infants with less dramatic feeding intolerance may or may not need to have their feedings stopped.

Consider: the infant’s feeding history. If the feeds were recently advanced in volume or caloric content, or transitioned to bolus, resuming the previously tolerated feeding regimen may alleviate problems.

Consider: the infant’s position. Feedings are usually best tolerated with the infant lying prone or on the right side.

Consider: the infant’s stool frequency. Some preterm infant’s will tolerate feeding better if they stool every 12- 24 hours. Symptoms may be relieved by administering a glycerin sliver per rectum.

Consider: the infant’s respiratory status. Infants on CPAP often have gaseous distension of their stomach and GI tract.

Approved at Collaborative Pathways meeting 5/24/00.