Background Evidence is inconsistent to support checking gastric residual volumes (GRv) in predicting feeding intolerance in preterm infants. GRv remains standard practice in guiding feeding advancement in several neonatal centres. We hypothesises that this practice delays establishment of full enteral feeding with associated complications.

Aims The effect on time to reach full feeds (120 ml/k/day) with not checking GRv in advancing feeds in preterm infants.

Design Single Centre, unmasked, parallel armed RCT

Inclusion criteria Infants recruited within 48hrs of birth with birth weight (BW) ≥1500 grams ≤ 2000 grams.

Exclusion criteria Major congenital malformations, asphyxia and BW ≤3^rd percentile

Randomization Variable number blocks stratified by BW

Study intervention GRv assessed only with bloody aspirates or with vomiting and abnormal abdominal examination.

Control GR volume assessed routinely with feeding advancement

Results 86 infants with BW 1750 ± 140 g and gestational age 32.1 ± 1.5 weeks were enrolled. There was no difference in time to reach full feeds with both groups. Enteral feeds 120 mL/kg/d were achieved at DOL 5.9 ± 1.7 and 5.7 ± 1.8 in study and control group respectively. There was no difference in episodes of feeding interruptions, incidence of sepsis, reaching BW, and 120% of BW between two groups. However, two infants in the control group developed NEC.

Conclusions Not checking GRv while advancing feeds in late preterm infants did not statistically reduce the time to achieve full enteral feeds however there were no adverse events noted with this practice. This study should be done in VLBW babies where GRv is a major hurdle to feeding advancement.