Gastric Residual to Predict Necrotizing Enterocolitis in Preterm Piglets As Models for Infants

JPEN J Parenter Enteral Nutr. 2021 Jan;45(1):87-93. doi: 10.1002/jpen.1814. Epub 2020 Feb 26.


Background: Necrotizing enterocolitis (NEC) is a serious intestinal inflammatory disease in preterm infants. High volume of gastric residual (GR) after oral feedings is often used as a predictor of NEC, but evidence is limited. Using NEC-sensitive preterm piglets as models, we hypothesized that GR mass and related plasma biomarkers predict early onset of NEC.

Methods: In total, 258 newborn preterm piglets were fed bovine milk-based formulas for 5 days. At euthanasia, the stomach, small intestine, and colon were evaluated for NEC lesions. Mass, acidity, gastrin, and bile acid levels were determined for GR content, together with gastrin, glucagon-like peptide 2 (GLP-2), and gastric inhibitory polypeptide (GIP) levels in plasma.

Results: In total, 48% of piglets had NEC lesions in the small intestine and/or colon. These piglets had higher GR mass (+32%, P < 0.001) and lower gastric bile acid concentrations (-22%, P < 0.05) than piglets without NEC lesions. The positive and negative predictive values for these markers were 34%-61%. Gastric acidity, gastrin, GLP-2, and GIP levels were similar for piglets with and without NEC lesions.

Conclusion: Elevated GR mass correlates positively with NEC lesions but may be a poor predictor of NEC, even when combined with other biomarkers. More knowledge about gastric emptying and gut transit in preterm neonates is required to understand how GR volume and composition relate to morbidities, such as NEC, in preterm neonates.

Keywords: enteral feeding; feeding intolerance; preterm infant.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Animals, Newborn
  • Cattle
  • Enterocolitis, Necrotizing* / diagnosis
  • Glucagon-Like Peptide 2
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Intestine, Small
  • Stomach
  • Swine


  • Glucagon-Like Peptide 2