How does feeding tolerance differ between preterm and term infants, and what sign indicates intolerance?

• A. Preterm infants may have immature GI motility; signs of intolerance include increasing gastric residuals, abdominal distension, vomiting, or inconsistent flatus.
• B. Term infants have more GI immaturity; intolerance is only vomiting.
• C. Preterm and term have identical tolerance; there are no signs.
• D. Tolerance is not assessed in NICU.

Answer: (A)

Feeding tolerance is tied to how mature the gut is. In preterm infants, the gastrointestinal tract isn’t fully developed, so gastric emptying is slower and intestinal peristalsis is immature. This makes it easier for feeds to overwhelm the gut, leading to feeding intolerance. The signs listed—rising gastric residuals before feeds, abdominal distension, vomiting, and inconsistent passage of gas—reflect the gut’s difficulty handling an entered volume and indicate intolerance. These signs help clinicians decide whether to pause, adjust, or advance feeds.

Term infants generally have more mature GI function, so they tolerate feeds more reliably and poor tolerance signs are less common. In the NICU, tolerance is monitored by tracking feed volumes, residuals, abdominal girth, vomiting, and stooling patterns to detect early signs of intolerance.