Characterization of esophageal motility and esophagogastric junction in preterm infants with bronchopulmonary dysplasia

Abstract

Background: To characterize esophageal motility and function of the esophagogastric junction (EGJ) in preterm infants with bronchopulmonary dysplasia (BPD). Methods: High-resolution manometry with impedance was used to investigate esophageal motility and EGJ function in 28 tube-fed preterm infants with BPD. Patients with BPD were studied at term age during oral feeding. Thirteen healthy term-aged infants were included as controls. Esophageal analysis derived objective measures to evaluate esophageal contractile vigor, bolus distension pressure, EGJ relaxation, and EGJ barrier function (in rest and during respiration). In addition, we investigated the effect of BPD severity on these measures. Key results: A total of 140 nutritive swallows were analyzed (BPD, n = 92; controls, n = 48). Normal esophageal peristaltic wave patterns were observed in all infants. BPD patients had higher distal contractile esophageal strength compared with controls (Kruskal-Wallis (KW) P = .048), and their deglutitive EGJ relaxation was comparable to controls. Severe BPD patients showed higher bolus distension pressures, higher EGJ resting pressures, and increased EGJ contractile integrals compared with mild BPD patients (Mann-Whitney U P = .009, KW P = .012 and KW P = .028, respectively). Conclusions and Inferences: Preterm infants with BPD consistently present with normal peristaltic esophageal patterns following nutritive liquid swallows. The EGJ barrier tone and relaxation pressure appeared normal. In general, infants with BPD do not have altered esophageal motor function. There is however evidence for increased flow resistance at the EGJ in severe BPD patients possibly related to an increased contractility of the diaphragm.

Verifying Feeding Tube Placement in Canine and Feline Neonates

“…Using a tube with the ared end trimmed may reduce regurgitation risks, as previously suggested (7). Reduced contractility of the gastrointestinal tract was observed in human preterm neonates (46,47), and in canine neonates, with a progressive increase of contractility 3-7 days after birth (48). Canine gastrointestinal maturation is a quick process implying that signi cant changes in the gastrointestinal tract may occur within the rst days of life, which is why this study was limited to less than one day old neonates.…”

Verifying the placement and length of feeding tubes in canine and feline neonates

“…A drop of milk intended to be used for the feeding procedure or water soluble veterinary lubricant may be used to grease the tube before insertion [ 7 ]. Reduced contractility of the gastrointestinal tract was observed in human preterm neonates [ 48 , 49 ] and in canine neonates, with a progressive increase in contractility occurring 3–7 days after birth [ 50 ]. Canine gastrointestinal maturation is an evolutionary process, and gastrointestinal barrier closure is completed very early, 16–24 h after birth [ 51 ].…”

What is the role of high‐resolution oesophageal manometry in paediatrics?

“…Commercial HRM catheters of 8‐French size, including a feeding lumen, are available. Thus HRM is technically viable in the paediatric setting, even in premature infants 5–10 . There is an emerging paediatric oesophageal motility literature showing that the spectrum of HRM‐classified motility disorders resembles that described for adults 11–13 .…”

“…Thus HRM is technically viable in the paediatric setting, even in premature infants. [5][6][7][8][9][10] There is an emerging paediatric oesophageal motility literature showing that the spectrum of HRMclassified motility disorders resembles that described for adults. [11][12][13] However, there are still major challenges for standardisation to enable reliable and meaningful results for routine clinical use.…”