OBJECTIVE The authors hypothesized that acute respiratory distress (ARD) delays gastric emptying. The objective was to test this hypothesis by assessing gastric emptying on the second and seventh days of life in premature infants with ARD resulting from pulmonary disease. METHODS Thirty-nine newborns with ARD starting on the first day of life were selected and paired with 39 healthy control newborns matched by weight (within 250 g). Gestational age was <or =35 weeks and birth weight was < or =1750 g for all subjects. Gastric emptying was assessed at 48.0 +/- 24.0 hours and at 168.0 +/- 24.0 hours of life. A test meal consisting of 3 mL/kg of 5% glucose in water labeled with phenol red was administered by gastric tube over 1 minute and gastric retention was determined as percent test meal remaining in the stomach 30 minutes after administration. RESULTS Gastric retention at 30 minutes varied considerably in both groups and was significantly higher (P < 0.01) in newborns with ARD (61.4%) than controls (51.8%) at 48.0 +/- 24.0 hours, decreasing significantly after partial or full remission of ARD at 168 +/- 24 hours of life. Gastric retention was 60.2% in newborns with feeding intolerance and 36.8% in tolerant newborns (P < 0.001) at 168 hours. ARD and periventricular or intraventricular hemorrhage were predictors of gastric retention at 48 +/- 24 hours of life, whereas feeding intolerance and gestational age were predictors of gastric retention at 168 +/- 24 hours. Gastric retention was inversely correlated with gestational age. CONCLUSIONS Gastric emptying is delayed in premature infants with ARD during the first 72 hours of life and may impair the initiation of enteral feeding.