Smarter feeding

As part of the Smarter Medicine: Smarter Talents initiative, Laura Renz and the neonatal team at the Children’s Hospital of Central Switzerland reviewed the routine practice of measuring gastric residuals in infants with feeding tubes.

While historically used to assess feeding tolerance, evidence shows that routine gastric residue measurement is not always needed and may unnecessarily delay growth and hospital discharge. Departmental guidelines were revised to implement a selective, indication-based approach, with aspirations performed only in the presence of defined clinical signs.

The Selective Approach

The primary objective of this initiative was to reduce routine gastric volume measurements to less than 5% of all meals. Departmental guidelines were revised to move away from routine checks and toward a clinically indicated approach. Under the updated protocol, gastric aspiration is performed only in the presence of clinical signs of feeding intolerance, suspicion of necrotising enterocolitis (NEC), or specific medical indications.

Key Outcomes

Following the implementation of the revised guidelines, a substantial reduction in low-value measurements was observed:

• Gastric residual measurements decreased from ~13% to 2.7%
• The target of remaining below 5% was exceeded
• High adherence to the revised guidelines was observed among nursing staff, despite the challenges associated shift-based workflows

This change shows that low-value interventions can be reduced in a targeted and successful manner in everyday clinical practice.A follow-up evaluation is planned for Summer 2026 to assess sustainability and long-term outcomes, including growth and length of hospital stay.

Laura is part of the Smarter Talents Program of Smarter Medicine Switzerland.

The CCHA supports the project by extracting and validating data before and after the guidelines are adjusted.