Which sign indicates feeding intolerance in preterm infants?

• A. Increasing gastric residuals.
• B. Decreased distension.
• C. Vomiting and abdominal distension.
• D. Regular, well-formed stools after feeds.

Answer: (B)

Feeding intolerance in preterm infants arises from an immature gastrointestinal system that struggles to handle enteral feeds. When the gut isn’t tolerating feeds, the signs reflect slowed gastric emptying and poor propulsion, leading to gas and fluid buildup in the intestines. Vomiting indicates the stomach is not managing the influx of feeds well, and abdominal distension shows the bowel is distending from retained air and fluids. Together, these findings point to intolerance and often prompt reassessment of feed volumes, timing, and possibly holding feeds to avoid further stress on the gut. In contrast, decreased distension or regular, well-formed stools after feeds suggest good tolerance, not intolerance, and increasing gastric residuals would be another sign pointing toward intolerance.