title: Transpyloric tube feeding in very low birthweight infants with suspected gastroesophageal reflux: impact on apnea and bradycardia.
abstract: OBJECTIVE
  Our aim was to assess the safety and efficacy of transpyloric tube feeding as a therapeutic option to reduce apnea and bradycardia in hospitalized very low birthweight (VLBW) infants with clinical signs suggestive of gastroesophageal reflux (GER).
  
  
  METHODS
  This was a retrospective single-center cohort study of VLBW infants hospitalized from 2001 to 2004 with signs of GER who received transpyloric enteral tube feedings. Apnea (>10 s) and bradycardia (<100 bpm) episodes were compared before and after the initiation of transpyloric feedings. The Wilcoxon signed-rank test was used to compare differences between cardiorespiratory episodes before and after treatment at 1-day and combined 3-day intervals. Events recorded to assess the safety of transpyloric feedings included death, sepsis and necrotizing enterocolitis (NEC).
  
  
  RESULTS
  A total of 72 VLBW infants with a median birthweight of 870 g (ranging from 365 to 1435 g) and gestational age of 26 weeks (from 23 to 31 weeks) were identified. The median weight at initiation of transpyloric feedings was 1297 g (from 820 to 3145 g) and infants received transpyloric feeds for a median duration of 18 days (from 1 to 86 days). After the initiation of transpyloric feedings, a reduction in apnea episodes from 4.0 to 2.5 (P=0.02) and a decrease in bradycardia episodes from 7.2 to 4.5 (P<0.001) was observed when comparing the total number of episodes for the 3 days before and after treatment. Five (6.9%) of the infants developed NEC while receiving transpyloric feedings. None of the infants receiving human milk (P=0.07) and 36% of those receiving hydrolysate-based formula (P<0.01) during transpyloric feeds developed NEC. No infants had late-onset culture-proven sepsis. Seven (9.7%) infants died before hospital discharge.
  
  
  CONCLUSIONS
  Transpyloric feedings, especially when limited to human milk, may safely reduce episodes of apnea and bradycardia in preterm infants with suspected GER. Prospective randomized studies are needed to determine the biological impact of bypassing the stomach, as well as the safety and efficacy of this intervention. The results of such studies could modify the current prevailing safety concerns regarding transpyloric feeding in this population.
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC 27710, USA. malco002@mc.duke.edu
authors.forename: W F
authors.initials: WF
authors.lastname: Malcolm
authors.forename: P B
authors.initials: PB
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Mears
authors.forename: R N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: C M
authors.initials: CM
authors.lastname: Cotten
mesh_terms: D001049:Apnea / Q000517:prevention & control*; D001919:Bradycardia / Q000517:prevention & control*; D002657:Child Development; D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D011247:Pregnancy; D011336:Probability; D011708:Pylorus; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain