Nursing practice of routine gastric aspiration in preterm infants and its link to necrotizing enterocolitis: is the practice still clinically relevant?

The practice of routine gastric residual aspiration in preterm infants remains controversial, with conflicting evidence
regarding its impact on necrotizing enterocolitis (NEC). As front-line caregivers, nurses play a vital role in gastric
aspiration procedures and must be informed by evidence. This quasi-experimental nursing study aimed to assess
whether gastric aspiration is clinically relevant in reducing the risk of NEC in preterm infants.
A total of 250 preterm infants from two NICUs in Egypt were allocated to the gastric aspiration (n = 125) and
non-aspiration (n = 125) groups. Feeding practices, gastric residuals, and incidence/severity of NEC were compared
between groups according to modified Bell’s criteria. Risk factors were analyzed using multivariate regression. There
were no significant baseline differences between the groups. The gastric residual attributes and feeding outcomes
did not differ substantially from aspiration. The overall incidence of NEC was 14–15%, with no significant differences
in the odds of onset or progression of NEC by stage between the groups. Lower gestational age and birth weight
emerged as stronger predictors of NEC. Routine gastric aspiration does not appear to directly prevent or reduce
the severity of NEC in this population. Although gastric residuals retain clinical importance, study findings question
assumptions that aspiration protects against NEC and informs nursing practice. Evidence-based feeding protocols
must continually evolve through ongoing research on modifiable risk factors for this devastating intestinal disease
in preterm infants.