Undigested -vs- Partially Digested Residuals

[Love_2_Learn]

Hi Everyone,

I hope I can find some information here to help me understand more about refeeding NG/OG residuals.

Some of our doctors and nurse practitioners say to refeed gastric residuals (they state the amount to refeed) which appear to look the same as the formula/breast milk did when it was fed to the baby 3 hours ago, and then others say to discard it and then feed the baby as usual. This is ordered when the baby is stooling well, has no signs of NEC like abdominal distention, venous patterning or discoloration, no yellow or green residuals, no A's & B's, etc. I realize that the babies need the enzymes and electrolytes in their stomach contents so maybe that's what they are thinking when having us refeed what looks like undigested milk. It's just that other places I've worked they usually did not refeed the residual unless it was definately partially digested. Of course I always do what they order but I've been wondering...

It kinda creeps me out to think food has been sitting in a stomach for 3 hours and is not partially digested yet... kinda like a very early sign of feeding intolerance or something like that.

I have looked in several books but don't find any real mention of the difference between "undigested" and "partially digested" residuals... most books simply say "residuals".

Can any of you wise nurses shine some light on this for me?

Thanks

[Gompers, BSN, RN]

Oh yeah. You definatly have to fill the gut to promote digestion. More craziness. It's an art , not a science.

Very interesting! :) Where I am, if the baby has a lot of residuals while on tropic feeds, the docs either keep going or stop them - but never increase them until there is a decrease in residulas. But I agree, the kids seem to do better once we increase the feeds rather than cut back on them, as long as their bellies look okay. Food for thought, literally...

[Love_2_Learn]

I appreciate all of your replies; I've learned so much already.

I'm wondering, does anyone know what makes some food look partially digested and some food look like it's fresh? Do you think it has something to do with the enzymes working on different parts of the food... like the part that looks partially digested is more carbohydrates and the undigested looking part is more protein or something hard for me to understand like that? I'm just curious...

Thanks!

[dawngloves, BSN, RN]

And I don't want to hijack the thread either...but going along the same lines as residuals. How often do you check them? I only check as often as I feed. So if the baby is only getting fed Q6, I check residuals Q6. Last week, I got report from a nurse who was checking residuals every 3-4 hours on a baby being fed Q6, and notifying the doctor of these residuals even though the baby wasn't due to eat for another 2-3 hours. Any thoughts?

Our docs would ask her, "Why are you checking residuals now??"

[dawngloves, BSN, RN]

I appreciate all of your replies; I've learned so much already.

I'm wondering, does anyone know what makes some food look partially digested and some food look like it's fresh? Do you think it has something to do with the enzymes working on different parts of the food... like the part that looks partially digested is more carbohydrates and the undigested looking part is more protein or something hard for me to understand like that? I'm just curious...

Thanks!

Now you've lost me.

[Gompers, BSN, RN]

I appreciate all of your replies; I've learned so much already.

I'm wondering, does anyone know what makes some food look partially digested and some food look like it's fresh? Do you think it has something to do with the enzymes working on different parts of the food... like the part that looks partially digested is more carbohydrates and the undigested looking part is more protein or something hard for me to understand like that? I'm just curious...

Thanks!

I would think that the longer the stomach worked on digestion, the more digested the residual would look. Simple as that.

If it's nice and curdled and there are gastric juices separating from it - LOVELY description, eh? - then it's pretty safe to say the kiddo's been working on it. If it looks like pure breastmilk or formula, then maybe it has just been sitting there since the last feeding, and the GI tract is not doing much.

[Love_2_Learn]

Yeah Gompers, that's just what I was thinking. My gut feeling is that after being in a stomach for 3 hours (bolus feedings) that the food should look the lovely partially digested way you mentioned. This is why I am wondering why it's not a concern (to some doctors/nurse practitioners) to see fresh looking milk that's been sitting in a stomach for 3 hours and just refeed it as if it was the wonderful partially digested type. I'm just trying to figure out what it is that makes it esentially ok to refeed undigested looking food. Am I making any sense?

[perfectbluebuildings, BSN, RN]

What about a babe that is getting bolus fed daytime and continuous at night, and when disconnected from a bolus feed (has a Mickey button), and the extension is taken off, there is formula that comes out of the button (not around, like a leakage, but from the stomach- I know I sound like an idiot)- what might be the issue there? Is that residuals? I know the babe was probably to get a new button soon... Thanks for any help.

[jnsatc]

We don't check residuals on our trophic feed babies (1cc q 4 or 8hrs) since it will take a while for the stomach to fill and then empty. We are starting to stop checking residuals unless we fill a need and then if a residual is 2/3 of the feed, we give it back and give the difference in fresh milk. The kid usually buys a NEC workup if we see a change in stools, increase in A's and B's, increased blood sugar, abdominal discoloration or distention. Any residuals that we do get is refed due to the electrolytes, however I tend to discard if it is very bilious or nasty looking, but that's my own preference.

s

[Gompers, BSN, RN]

We don't check residuals on our trophic feed babies (1cc q 4 or 8hrs) since it will take a while for the stomach to fill and then empty.

See, that's what I think we should do, too. We check them, and at least half the time, we stop tropic feeds because the baby isn't digesting them. But I read a post here that mentioned needing MORE food to really stimulate the GI tract, so it makes sense that tropic feeding isn't enough sometimes. That really, instead of making the baby NPO, maybe we should either keep going with the 1cc Q4H feeds, or bump them up to 2cc or Q2H instead. Just following the abdominal assessment and not stopping feeds every time seems like a good idea to me.

[LilPeanut, MSN, RN, NP]

Of course in our NICU, we'll occasionally have issues because the 1.5ml q4 bolus feed isn't being pushed down with enough air and the reason it's not digested is because it never reached the tummy :rofl:

[Mimi2RN, ASN, RN]

I had one baby on Sim 20SC 1ml q3 and the other on 1ml 6 the other night. Both had miniscule resids of clear fluid. I agree about increasing the feeds, but slowly. I think they were both ready for more. On the other hand, my 3 d/o 35 weeker had her feeds increased to 45ml, 14 ml resid (wasted). Then backed down to 35 ml, next resid 9 ml (also wasted). Next feed she was tubed 20 ml, and within an hour had vomited back at least half of that, curdled. Fourth feed we held.........she was trying hard to tell us something! Wish the docs would listen.