Impact of Feeding Strategies on the Frequency and Clearance of Acid and Nonacid Gastroesophageal Reflux Events in Dysphagic Neonates

Abstract

Background Feeding difficulties and gastroesophageal reflux (GER) are common problems in neonates. The authors hypothesize that GER could be influenced by feeding mechanics by evaluating the effects of feeding volumes, feeding durations, feeding flow rates, and caloric density on the chemical composition and clearance of GER in dysphagic neonates. Methods Symptomatic dysphagic neonates (n = 35) underwent evaluation for suspected GER using pH-impedance methods. Results The proportions of acid and nonacid GER were different during the first, second, and third postprandial hours (P < .0001). Prolonged feeding duration was significantly associated with decreased total, nonacid GER and BCT (P < .03). Significant positive correlations (P < .05) were detected between feeding flow rate vs frequency of total, nonacid GER and BCT. Significant positive correlation (P = .002) was noted between feeding volume and BCT. BCT decreased with each hourly interval (analysis of variance [ANOVA] P < .05); however, ACT increased with each hourly interval (ANOVA P = .05). Comparison between BCT and ACT at each postprandial hour is remarkable for longer ACT during the second and third hours after the initiation of feed (P ≤ .001). No significant correlation was noted between the milk types (breast milk or formula) or caloric density with regard to the GER characteristics. Oral-fed infants had more GER events than gavage-fed infants. Conclusions Prolonged feeding durations and slower flow rates are associated with decreased frequency of GER. Modification of feeding duration and flow rate can be a useful adjunct to ameliorate GER in dysphagic neonates.

Are Infants with Bronchopulmonary Dysplasia Prone to Gastroesophageal Reflux? A Prospective Observational Study with Esophageal pH-Impedance Monitoring

“…33 The feeding duration followed our general NICU policy: preterm infants received feeds every 3 hours, and each feed was administered over 20-30 minutes, with small variations depending on infants' tolerance; it is unlikely that significant differences in feeding duration could have occurred and influenced GER features.…”

Practice Variance, Prevalence, and Economic Burden of Premature Infants Diagnosed With GERD

“…3,4,17 These symptoms may occur because premature infants have immature and maladaptive motility mechanisms and are fed a larger volume per kilogram of body weight. 18 Therefore, it is likely that prolonged hospitalization of infants diagnosed with GERD may be related to delayed adaptation to esophageal provocation from gastroesophageal reflux events. In a single-center study in 1998, the difference in total hospital charges for premature infants with clinically significant GERD was nearly $50 000, which, if adjusted for inflation, is similar to the $70 000 difference reported in our study.…”

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

“…GERD was treated with pharmacologic therapy and decreasing feeding flow rates. (21) Rarely, poor gut motility was treated with short-term prokinetic agents (Erythromycin or Augmentin) to improve oral feeding and feeding intolerance.…”