Impact of feeding strategies on the frequency and clearance of acid and nonacid gastroesophageal reflux events in dysphagic neonates.
BACKGROUND
Feeding difficulties and gastroesophageal reflux (GER) are common problems in neonates. The authors hypothesize that GER could be influenced by feeding mechanics by evaluating the effects of feeding volumes, feeding durations, feeding flow rates, and caloric density on the chemical composition and clearance of GER in dysphagic neonates.


METHODS
Symptomatic dysphagic neonates (n = 35) underwent evaluation for suspected GER using pH-impedance methods.


RESULTS
The proportions of acid and nonacid GER were different during the first, second, and third postprandial hours (P < .0001). Prolonged feeding duration was significantly associated with decreased total, nonacid GER and BCT (P < .03). Significant positive correlations (P < .05) were detected between feeding flow rate vs frequency of total, nonacid GER and BCT. Significant positive correlation (P = .002) was noted between feeding volume and BCT. BCT decreased with each hourly interval (analysis of variance [ANOVA] P < .05); however, ACT increased with each hourly interval (ANOVA P = .05). Comparison between BCT and ACT at each postprandial hour is remarkable for longer ACT during the second and third hours after the initiation of feed (P ≤ .001). No significant correlation was noted between the milk types (breast milk or formula) or caloric density with regard to the GER characteristics. Oral-fed infants had more GER events than gavage-fed infants.


CONCLUSIONS
Prolonged feeding durations and slower flow rates are associated with decreased frequency of GER. Modification of feeding duration and flow rate can be a useful adjunct to ameliorate GER in dysphagic neonates.
Section of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio 43205, USA. sudarshan.jadcherla@nationwidechildrens.org
Sudarshan R
SR
Jadcherla
Chin Yee
CY
Chan
Rebecca
R
Moore
Manish
M
Malkar
Christopher J
CJ
Timan
Christina J
CJ
Valentine
D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology*; D017097:Electric Impedance; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D004947:Esophagus / Q000503:physiopathology; D005247:Feeding Behavior; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology* / Q000517:prevention & control; D006801:Humans; D006863:Hydrogen-Ion Concentration; D041943:Infant Formula; D007231:Infant, Newborn; D008297:Male; D008895:Milk, Human; D019518:Postprandial Period