Abstract 1213 Poster Session IV, Tuesday, 5/4 (poster 233)

Objective: Achievement of adequate enteral nutrition is vital for growth and development in premature infants. In attempts to foster success with enteral nutrition, we investigated the onset of stooling as a surrogate for effective gastrointestinal motility and gastrointestinal maturity. We set out to determine whether the earlier onset of stooling is associated with earlier achievement of full feedings and less feeding intolerance, defined as 2 consecutive residuals >50% of feeding volume and/or increase in abdominal girth >2 cm.

Methods: Feeding characteristics, collected prospectively in preparation for a feeding study, of a cohort of premature infants (GA≤36 weeks), were analyzed using Statview, a software package. Groups were compared for number of days to stool, number of days to full feeds, onset of enteral feeds, feeding intolerance, number of NPO episodes, total days NPO, and number of days of abdominal distension.

Results: The cohort consisted of 33 infants with an average birthweight of 1736.5±570 grams (range 670-3160 grams). Average gestational age was 31.8±3 weeks (range 25-36 6/7 weeks). There was a significant correlation between the number of days to stool and number of days to full feeds, p=0.0002; this remained statistically significant when gestational age was controlled in the analysis, p=0.004 in the early gestation group (<31 weeks) and p=0.006 in the late gestation group (≥31 weeks). There was no correlation between days to stool and onset of enteral feeds (p=0.69). Greater than 7 days to first stool was significantly associated with feeding intolerance (r=0.675, p=0.03), number of NPO episodes (r=0.845, p<0.0005), and with total days NPO (r=0.793, p<0.0021). As expected the number of days to full feeds was statistically significant when associated with days of feeding intolerance (r=0.744, p=0.02), number of NPO episodes (r=0.772, p=0.0054), total days NPO (r=0.822, p=0.0019), and number of days of abdominal distension (r=0.677, p=0.022).

Conclusions: Fewer days to first stool is associated with decreased feeding intolerance and earlier achievement of full enteral feedings. Time to first stool may be used as a surrogate for effective intestinal motility and maturity. This suggests that in those infants who demonstrate earlier effective GI motility, more rapid progression to full enteral feedings may be achieved safely. Such an approach could result in cost savings with regard to fewer hospital days, fewer days of parenteral nutrition, and fewer comorbidities.