Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate

Omari, Taher; Rommel, Nathalie; Staunton, Esther; Lontis, Ros; Goodchild, Louise; Haslam, Ross; Dent, John; Davidson, Geoffrey P.

doi:10.1016/j.jpeds.2004.05.026

Cited by 115 publications

(62 citation statements)

References 19 publications

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“…It is possible that a small amount of air reflux preceded liquid reflux into the esophagus, which could account for the time differences observed between the propagation of the pressure wave compared with the fluid entry wave by the MII criteria. We think it is unlikely because 1) MII tracings were carefully scrutinized to assess for presence of air in the GER refluxate; 2) we studied subjects in the right decubitus position, which is associated with predominantly liquid reflux (13); and 3) we did not see air reflux preceding liquid reflux on our US images; the latter is very sensitive in detecting air in the esophagus. The choice of subject position in our study also explains the differences in the frequency of air reflux between ours and other studies.…”

Section: Discussionmentioning

confidence: 99%

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Tipnis

Liu²,

Puckett³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

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Tipnis, Neelesh A., Jianmin Liu, James L. Puckett, and Ravinder K. Mittal. Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging. Am J Physiol Gastrointest Liver Physiol 290: G1149-G1156, 2006. First published January 26, 2006 doi:10.1152/ajpgi.00361.2005.-An increase in intraesophageal pressure during transient lower esophageal sphincter (LES) relaxation [referred to as common cavity (CC) pressure] is thought to be a marker of gastroesophageal reflux (GER). Multiluminal impedance (MII) measurement is a sensitive marker of reflux entry into the esophagus during GER. We recorded GER using esophageal pressure, pH, impedance, and intraluminal ultrasound (US) images to understand the genesis of the esophageal CC pressure. Nine normal subjects underwent simultaneous MII/pH/pressure and US image recording of the esophagus for 2 h following a standardized meal. MII and pressure transducers were located at 5 and 15 cm above the LES. The US transducer and pH sensors were also placed at 5 cm above the LES. Refluxate entry into the esophagus by MII criteria was determined relative to the onset of CC pressure wave. Esophageal lumen cross-sectional area (CSA) and muscle CSA during GER were determined from the US images. Eighty liquid GER episodes identified using MII criteria, of which 55 were clearly associated with CC pressure waves, were analyzed. The GER reached 15 cm above LES in 49 of 55 (89%) by MII criteria, but the CC pressure wave was observed at 5 and 15 cm during all episodes. The propagation of the CC pressure wave was simultaneous between 5 and 15 cm during 49 of 55 (89%) of the GER episodes, but reflux entry by MII criteria was retrograde during 53 of 55 (96%) of these episodes. During 5 airreflux episodes, MII showed a simultaneous reflux entry between the 5-and 15-cm site, however, the CC pressure preceded reflux entry during all of these episodes. There was poor correlation between the luminal CSA and the magnitude of CC pressure (R2 ϭ 0.144). US images revealed a close temporal correlation between CC pressure and the increase in esophageal muscle thickness and muscle CSA (markers of longitudinal muscle contraction). Disassociation between CC pressure and MII-detected reflux suggests that the onset of CC pressure is not due to GER. We speculate that longitudinal muscle contraction plays an important role in the genesis of CC pressure.

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Section: Discussionmentioning

confidence: 99%

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Tipnis

Liu²,

Puckett³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Prone or left lateral positioning rather than supine or right lateral reduces GORD in preterm and term infants 27 28 29 30 31. This is not recommended for infants in the community with GORD because of the accepted increased risk of SIDS with prone positioning but is safe in preterm infants in hospital receiving cardio-respiratory monitoring.…”

Section: Management Optionsmentioning

confidence: 99%

Gastrooesophageal reflux disease in preterm infants: current management and diagnostic dilemmas

Birch

Newell²

2009

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Gastrooesophageal reflux disease (GORD) provides a diagnostic and therapeutic challenge to many neonatologists. Reflux of gastric contents is common in preterm infants but usually not pathological. GORD is frequently diagnosed despite the lack of a fully identified clinical syndrome and of a truly valid diagnostic test. Treatment modalities, for which there is little convincing evidence regarding efficacy, are commonly instigated for troublesome symptoms attributed to GORD. Diagnosis is so problematic in preterm infants that GORD is starting to be described as the clinical syndrome that responds to anti-reflux treatment. We discuss the dilemmas facing us when dealing with this condition, summarise the best available evidence regarding diagnosis and management, and use it to inform a suggested treatment pathway. We introduce the concept of a clinical scoring system to aid the diagnosis and monitoring of GORD in preterm infants and highlight areas where further research would be beneficial.

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“…Several studies have reported that gastric emptying or the gastric residual volume are affected by the body position of preterm infants (Cohen et al, 2004;Omari et al, 2004;Van Wijk et al, 2007). However, the results of previous studies are inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study

Chen

Tzeng

Gau

et al. 2013

International Journal of Nursing Studies

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Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate

Cited by 115 publications

References 19 publications

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Gastrooesophageal reflux disease in preterm infants: current management and diagnostic dilemmas

Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study

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