Marianna Ferlini

Gastro-oesophageal reflux increases the number of apnoeas in very preterm infants.

Objective: To document the existence of a relationship between apnoea of prematurity (AOP) and gastro-oesophageal reflux (GER) in preterm infants. Setting: Neonatal intensive care unit. Patients: Twenty-six preterm infants (gestational age ⩽32 weeks) with recurrent apnoeas. Intervention: Simultaneous and synchronised recording of polysomnography and pH-impedance monitoring (pH-MII). Polysomnography detects and characterises apnoeas, by recording of breathing movement, nasal airflow, electrocardiogram and pulse oximeter saturation. pH-MII is the state-of-the-art methodology for GER detection in preterm newborns. Main outcome measures: Relationship between AOP and GER, which were considered temporally related if both started within 30 seconds of each other. Results: One hundred and fifty-four apnoeas out of 1136 were temporally related to GER. The frequency of apnoea during the 1-minute time around the onset of GER was significantly higher than the frequency detected in the GER-free period (p = 0.03). Furthermore, the frequency of apnoea in the 30 seconds after GER (GER-triggered apnoeas) was greater than that detected in the 30 seconds before (p = 0.01). A great inter-individual variability was documented in the proportion of GER-triggered apnoeas. A strong correlation between total number of apnoeas and the difference between apnoeas detected 30 seconds after and before GER was found (p = 0.034). Conclusions: Our data show that a variable rate of apnoeas can be triggered by GER in very preterm infants. Further studies are needed to recognise clinical features that identify those patients who are more susceptible to GER-triggered apnoeas.

Lack of efficacy of a starch-thickened preterm formula on gastro-oesophageal reflux in preterm infants: a pilot study

Background: Gastro-oesophageal reflux (GOR) is common in preterm infants; conservative interventions (i.e. dietary changes) should represent the first-line approach. Aim: To evaluate by combined pH and impedance monitoring (pH-MII) the effect of a new preterm formula thickened with amylopectin (TPF) on GOR features in symptomatic preterm infants. Methods: Twenty-eight symptomatic preterm newborns underwent a 24-hour pH-MII; each baby received eight meals (four of TPF and four of a preterm formula [PF]). GOR indexes (number, acidity, duration and height of GORs) after TPF and PF meals were compared by Wilcoxon Signed Ranks Test. Viscosity of PF and TPF was measured. Results: TPF significantly decreased the number of acid GORs detected by pH-monitoring (TPF vs. PF: median 20 vs. 24.5, p = 0.009), while it had no influence on Reflux Index (RIpH), nor on acid and non-acid GOR indexes detected by MII, GOR physical features, and GOR height. TPF’s viscosity was extremely higher than PF’s, and further increased at pH 3 after the addition of pepsin. Conclusions: The new formula was found to reduce the number of acid GORs detected by pH-monitoring; it did not reduce neither total oesophageal acid exposure nor non-acid GORs. At present its extended clinical use cannot be recommended.

311 Effects of Thickening of Human Milk on Ger in Preterm Infants: A Crossover Study Using Simultaneous Intraluminal Impedance and pH-Monitoring

Introduction: Regurgitation and gastroesophageal reflux (GOR) are often observed among preterm infants. A recent study indicates that the use of thickened milk reduces the number and intensity of buffered GOR detected by intraluminal impedence among term neonate. The aim of our study was to evaluate the efficacy of thickening expressed HM in preterm infants, using simultaneous intraluminal impedance and ph-monitoring.Methods: Five preterms (GE range 27–32 ws. BW 570 g-1900 g) were studied. They were on full enteral feeding and presented frequent regurgitations and/or post prandial desaturations. All infants received 8 meals/day using HM fortified with EOPROTIN 3% and added, in alterned meals, with 1.5 % of starch (70% sweet corn/ 30 % potato). A simultaneos intraluminal impedence (IIM) and pH monitoring was perormed for 24 hours. No difference was observed for number of GOR IIM episodes (170 in thickened milk TM vs 146 in not thickened milk NTM), total length (seconds) of GOR (3689 in TM vs 3262 in NTM), mean duration (seconds) of GOR (21.3 in TM vs 23.4 in NTM) and GOR height (5.54 cm in TM vs 6.1 cm in NTM)Conclusions: These preliminary data show that thickening HM by starch does not reduce GOR in pretermsIntroduction: Regurgitation and gastroesophageal reflux (GOR) are often observed among preterm infants. A recent study indicates that the use of thickened milk reduces the number and intensity of buffered GOR detected by intraluminal impedence among term neonate. The aim of our study was to evaluate the efficacy of thickening expressed HM in preterm infants, using simultaneous intraluminal impedance and ph-monitoring.Methods: Five preterms (GE range 27–32 ws. BW 570 g-1900 g) were studied. They were on full enteral feeding and presented frequent regurgitations and/or post prandial desaturations. All infants received 8 meals/day using HM fortified with EOPROTIN 3% and added, in alterned meals, with 1.5 % of starch (70% sweet corn/ 30 % potato). A simultaneos intraluminal impedence (IIM) and pH monitoring was perormed for 24 hours. No difference was observed for number of GOR IIM episodes (170 in thickened milk TM vs 146 in not thickened milk NTM), total length (seconds) of GOR (3689 in TM vs 3262 in NTM), mean duration (seconds) of GOR (21.3 in TM vs 23.4 in NTM) and GOR height (5.54 cm in TM vs 6.1 cm in NTM)Conclusions: These preliminary data show that thickening HM by starch does not reduce GOR in preterms