title: A thickened formula does not reduce apneas related to gastroesophageal reflux in preterm infants.
abstract: BACKGROUND
  Apnea of prematurity (AOP) occurs frequently in preterm infants and a variable proportion of AOP can be induced by gastroesophageal reflux (GER). Conservative treatment, including dietary modifications, should be the first-line approach for both GER and GER-related apneas in this population.
  
  
  OBJECTIVE
  To evaluate the efficacy of a starch-thickened preterm formula (PF) in reducing the frequency of apneas related to GER.
  
  
  METHODS
  Preterm infants with AOP were studied by combined impedance and pH monitoring and polysomnography. The 6-hour study period included two feeds, one of a commercially available PF and one of the same formula thickened with amylopectin (TPF). GER indexes, apneas and GER-related apneas detected after TPF and PF feeds were compared by Wilcoxon signed-rank test.
  
  
  RESULTS
  24 infants were studied. During 140 h of registration, 289 apneas (147 after TPF and 142 after PF; p = 0.876), and 861 GER episodes (400 after TPF and 461 after PF; p = 0.465) were recorded. No difference in the number of AOP was found between TPF and PF. A significant reduction in acid exposure was found after TPF; there was no influence on non-acid GER indexes. The frequency of GER-related apneas did not differ between TPF and PF.
  
  
  CONCLUSIONS
  A formula thickened with amylopectin did not reduce the number of AOP or GER-related apneas. It reduced acid GER features but had no effect on non-acid GER indexes. Future research should focus on exploring different conservative strategies to treat GER-related apneas in preterm infants.
authors.affiliation: Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy. luigi.corvaglia@unibo.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Corvaglia
authors.forename: Monica
authors.initials: M
authors.lastname: Spizzichino
authors.forename: Arianna
authors.initials: A
authors.lastname: Aceti
authors.forename: Elena
authors.initials: E
authors.lastname: Legnani
authors.forename: Elisa
authors.initials: E
authors.lastname: Mariani
authors.forename: Silvia
authors.initials: S
authors.lastname: Martini
authors.forename: Barbara
authors.initials: B
authors.lastname: Battistini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faldella
mesh_terms: D001049:Apnea / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D041943:Infant Formula / Q000008:administration & dosage* / Q000737:chemistry*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D008297:Male; D017286:Polysomnography; D014783:Viscosity