Enrico Bertino

Esophageal Bolus Transit in Newborns with Gastroesophageal Reflux Disease Symptoms: A Multichannel Intraluminal Impedance Study

Purpose The aim of this study was to evaluate bolus transit during esophageal swallow (ES) and gastroesophageal reflux (GER) events and to investigate the relationship between the characteristics of ES and GER events in a population of term and preterm newborns with symptoms of gastroesophageal reflux disease (GERD). Methods The study population consisted of term and preterm newborns referred to combined multichannel intraluminal impedance (MII) and pH monitoring for GERD symptoms. The frequency and characteristics of ES and GER events were assessed by two independent investigators. Statistical significance was set at p<0.05. Results Fifty-four newborns (23 preterm) were included in the analyses. Median bolus head advancing time corrected for esophageal length (BHATc) was shorter during mealtime than during the postprandial period (median, interquartile range): 0.20 (0.15-0.29) s/cm vs. 0.47 (0.39-0.64) s/cm, p<0.001. Median bolus presence time (BPT) was prolonged during mealtime: 4.71(3.49-6.27) s vs. 2.66 (1.82-3.73) s, p<0.001. Higher BHATc (p=0.03) and prolonged BPT (p<0.001) were observed in preterm newborns during the postprandial period. A significant positive correlation between BHATc and bolus clearance time was also observed (ρ=0.33, p=0.016). Conclusion The analysis of ES and GER events at the same time by MII provides useful information to better understand the physiopathology of GERD. In particular, the analysis of BHATc during the postprandial period could help clinicians identify newborns with prolonged esophageal clearance time due to impaired esophageal motility, which could allow for more accurate recommendations regarding further tests and treatment.

Donor milk: current perspectives

Mothers own milk is widely recognized as the optimal feeding for term infants, but increasing evidence exists of its benefits also for sick and preterm infants in neonatal intensive care units. However, the nutritional needs for appropriate growth and neurodevelopmental out- comes of such a particular population of infants should be attentively evaluated, considering also the indication to an appropriate fortification of human milk. The target is to achieve growth potential for preterm newborns while ensuring good metabolic outcomes and normal neurological development. When mothers milk is unavailable or in short supply, donor human milk (DHM) represents the second best choice and, although somewhat modified by the Holder pasteurization process, it preserves many benefits when compared to formula, as documented by more and more reports, randomized controlled trials, and meta-analyses published in the past few years. Evidence exists of the protection exerted by DHM from necrotizing enterocolitis, while further studies are required to look at possible beneficial effects regarding infections, bronchopulmonary dysplasia, long-term cardiovascular risk factors, feeding tolerance, neurological outcome, and allergy. Finally, the concern that the use of DHM might decrease preterm infant breastfeeding is being raised. Conversely, publications exist showing that the use of DHM in the neonatal unit

A10 NEONATAL THROMBOSIS: ANALYSIS OF OUTCOME AT 24 MONTHS IN A SINGLE NEONATAL INTENSIVE CARE UNIT IN THE LAST FIVE YEARS

Objective: MII/pH is the recommended technique for GER detection in infants because of its ability to detect both acid and nonacid reflux. Currently, reflux events are analyzed considering pH values and quantitative parameters (number, duration and proximal extent); aim of this study was to realize a qualitative analysis, defining and classifying GER patterns, and assess the existence of a correlation between reflux patterns and duration of symptoms. Methods: Forty-eight infants with symptoms of GER and not receiving therapy underwent 24h-MII/pH study in the first month of life. Ten GER patterns were described and classified according to the features of MII/pH tracings. Patients were divided into two groups according to symptom duration (cut off: 6 months) and MII/pH variables were compared between these groups. Results: The MII/pH variables obtained by a traditional MII/pH analysis showed that patients with prolonged symptoms had a significant increase in IBEI%, reflux frequency (p < 0.001), reflux duration, number of complete events and duration of acid episodes (p < 0.005). All reflux patterns were identified and a higher frequency and percentage of intermittent refluxes (p < 0.001 and p < 0.005 respectively) and combined refluxes were observed in the same group. Conclusions: In this study we introduced a new qualitative method for the analysis of MII/pH tracings. This method widens the potential of MII/pH. The ability to provide prognostic information by the qualitative analysis could influence clinical decision making as well as the detection of specific reflux patterns could give MII/pH a role in individualizing therapeutic strategy. GENETIC BASIS OF DISEASE

Postnatal Weight Increase and Growth Velocity of Preterm Very Low Birth Weight Infants: Perspectives on Absolute Velocity Charts

Very low birth weight (VLBW) infants’ survival has greatly increased in the last few decades thanks to the improvement in obstetrical and neonatal care. These neonates represent about 1–1.5% of all liveborn infants in developed countries and they constitute the large majority of the population in neonatal intensive care units (NICUs). The correct evaluation of postnatal growth of these babies is nowadays of primary concern, although the definition of their optimal postnatal growth pattern is still controversial. It is known that VLBW infants have a specific postnatal growth pattern markedly different from that of higher birthweight full-term infants. Prospective longitudinal studies are needed to trace VLBW infants’ growth charts not only for weight but also for length and head circumference. These charts will be a useful tool to monitor postnatal growth of VLBW infants both during hospitalisation and after discharge, up to 2 or 3 years of age. A useful tool in VLBW infants growth evaluation could also be absolute velocity charts that, allowing a better and earlier identification of growth anomalies, could permit the observation of phenomena not yet visible on distance charts. An “extrauterine growth restriction” during hospitalisation is well known in VLBW infants, in particular VLBW infants with pathological conditions fail to thrive, but it is still not precisely known in which postnatal age periods and to what extent some factors act on growth pattern.

Esophageal Bolus Transit in Newborn with Gastroesophageal Reflux

Background and aim: Gastroesophageal dismotility due to immaturity is primarily involved in the pathogenesis of gastroesophageal reflux (GER) in newborns. Impaired swallowing patterns could influence refluxes characteristics and esophageal acid exposure. Multichannel Intraluminal Impedance (MII) is a novel technique to evaluate GER, and it has been used to evaluate esophageal bolus transit in adults and children, but data on its use in newborns are scanty.The aim of this study was to investigate the relation between esophageal motor disfunction and GER.Methods: Esophageal bolus transit was evaluated in 16 term newborns aged 15-30 days, who underwent 24h-pH/MII analysis for clinical suspect of GER disease. Eight patients had ≥5% time with esophageal pH< 4 (GER positive) and the other 8 patients had < 5% time with esophageal pH< 4 (GER negative). Bolus Head Advance Time (BHAT) and Total Bolus Transit Time (TBTT) were assessed on 3-hours intervals of MII recording.Results: BHAT and TBTT were calculated on a total of 1056 swallowing events MII detected.Table 1BHAT and TBTT observed during meal were shorter than in the fasting periods in both groups (p< 0.001). During meal, TBTT, but not BHAT, was longer (p=0.03) in the GER positive than in the GER negative group.Conclusions: Our results support that esophageal motor disfunction contributes to the pathogenesis of GER in newborns, impairing esophageal clearance.