Changes postnatal in gastric emptying in early life Maria A. Carlos, MD, Paul S. Babyn, MDCM, Margaret A, Marcon, MD, and Aideen M. Moore, MD Fram the Department of Pediatrics, Divisions of Neonatology, Department of Diagnostic Imaging and Gastroenterology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Objective: To study the pattern of gastric emptying in very premature infants and to determine whether there are changes with postnatal age and the ability to tol- erate feedings. Methods: Sequential ultrasound measurements of the gastric antral cross-sec- tional area were obtained in 32 infants (mean gestational age, 26 _ I weeks) be- fore and after feeding for 2 hours. Studies were carried out after initiation of feed- ings, when full feedings were received, and at 32 weeks. Infants classified as feeding intolerant (n = 9) were also studied when feedings were restarted. Gastric emptying was assessed by the time taken for antral cross-sectional area to reach maximal value and to decrease to half the maximal increment (half-antral clear- ance). Results: Delayed antral distention was observed at the time of the initial study in both feeding-tolerant (8 of 23) and feeding-intolerant (8 of 9) infants; however, there were significant differences in times for maximal antral distention (p <0.002) and half-antral clearance (p <0.006) between the feeding-tolerant and feeding- intolerant infants. By the time of full feedings, the feeding-intolerant infants showed immediate gastric emptying but still had a longer half-antral clearance time (p <0.0 I). By 32 weeks, all infants had immediate antral distention and a more ma- ture curvilinear pattern of gastric emptying. Conclusions: Knowledge of these different patterns of gastric emptying in very premature infants may lead to the development of more rational feeding strate- gies. (J Pediatr 1997; 130:931-7) Recent studies have demonstrated the benefit of early enteral feedings in preterm infants, including reduced metabolic complications associated with parenteral nutrition, improved tolerance to enteral feeding, and decreased duration of hos- pital stay. 1-5 There is no association between early introduc- tion of enteral feedings and necrotizing enterocolitis.68 Submitted for publication Mar. 26, 1996; accepted Nov. 12, 1996. Reprint requests: Aideen M. Moore, MD, Department of Pediatrics, Division of Neonatology, Hospital for Sick Children, 555 Univer- sity Ave., Toronto, Ontario, M5G 1X8, Canada. Dr. Maria Carlos was awarded the Trainee Start-up Fund from the Hospital for Sick Children Research Institute. Copyright © 1997 by Mosby-Year Book, Inc. 0022-3476/97/$5.00 + 0 9/21/79361 However, feeding intolerance develops in some very pre- mature infants with early introduction of feedings. Little is known about gastric motility and gastric empty- ing in very premature infants. At 7 months of gestation, the ACSA Antral cross-sectionalarea FI Feeding intolerant FT Feeding tolerant NEC Necrotizing enterocolitis muscles and nerve plexuses of the stomach appear mature, although the stomach wall is thin compared with normal in- fants.9, 10 Amniography has provided evidence of the human fetus emptying swallowed amniotic fluid from the stomach and suggested an increase in fetal gastrointestinal motility and rate of propagation of gastric contents after 28 weeks.ll 931