title: Association between tracheal pepsin, a reliable marker of gastric aspiration, and head of bed elevation among ventilated neonates.
abstract: OBJECTIVE
  To determine the frequency of tracheal pepsin in ventilated neonates and whether the angle of head elevation was associated with tracheal pepsin.
  
  
  METHODS
  Serial trachael samples (at 3, 7, 14, 21 and 28 days of ventilation) were obtained from intubated, ventilated very low birth weight infants. Presence of tracheal pepsin was determined by Western blot analysis using a specific anti-human pepsin antibody.
  
  
  RESULTS
  Tracheal pepsin was detected in 35/66 (53%) of the ventilated neonates (birthweight: 798 ± 268 grams [mean ± standard deviation]). Neonates whose head elevation was in the upper quartile (≥14 degrees) during the first sampling time (day 3) were less likely (4/16 vs 9/10, P = 0.0013) to have tracheal pepsin when compared to neonates whose head elevation was in the lowest quartile (≤8 degrees).
  
  
  CONCLUSIONS
  Pepsin, a marker for gastric secretion aspiration, was detected in 53% of ventilated low birth weight neonates; early elevation of the head of the bed was associated with a lower rate of tracheal pepsin.
authors.affiliation: Department of Pediatrics, Wheaton Franciscan Healthcare-St Joseph Hospital, Milwaukee, WI, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Garland
authors.affiliation: Department of Pediatrics, Wheaton Franciscan Healthcare-St Joseph Hospital, Milwaukee, WI, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Alex
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: N
authors.initials: N
authors.lastname: Johnston
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Yan
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Werlin
mesh_terms: D001513:Beds; D015415:Biomarkers / Q000378:metabolism; D015153:Blotting, Western; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal / Q000379:methods; D056888:Patient Positioning / Q000379:methods*; D010434:Pepsin A / Q000378:metabolism*; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial; D063466:Respiratory Aspiration of Gastric Contents / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000517:prevention & control*; D014132:Trachea / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010434:Pepsin A
keywords: Aspiration; gastroesophageal reflux; ventilator associated pneumonia; very low birth weight infants