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

Nobile, Stefano; Noviello, C.; Cobellis, Giovanni; Carnielli, Virgilio P.

doi:10.1016/j.jpeds.2015.05.005

Cited by 40 publications

(25 citation statements)

References 37 publications

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“…CSI was not reduced in BPD and was comparable in patients with BPD irrespective of treatment for GER. This finding is consistent with evidence that many patients with BPD, who are treated for GERD, fail to demonstrate more GER on pH-monitoring14,27,28 An alternative hypothesis Mann-Whitney U test P < .01 mild vs severe BPD. Augmentation of DPE suggests greater bolus flow resistance during emptying into the stomach 12.…”

supporting

confidence: 82%

“…12,13 With regards to gastroesophageal reflux (GER), data on the increased prevalence in infants with BPD are conflicting. 14 The predominant mechanism of GER in preterm infants with and without BPD is transient relaxations of the lower esophageal sphincter (TLESRs). 9,15 Recently, an improved manometric diagnostic parameter, the EGJ contractile integral (EGJ-CI), has been advocated as a measure to investigate non-deglutitive EGJ function in adults with GERD; however, its relevance in the neonatal and pediatric setting is unclear.…”

Section: Introductionmentioning

confidence: 99%

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

Rayyan

Omari

Debeer

et al. 2020

Neurogastroenterology Motil

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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.

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supporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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

Rayyan

Omari

Debeer

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

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“…In a prospective observational cohort study that enrolled a total of 46 preterm infants born before 32 weeks of gestation and suspected of having GERD, infants with BPD had increased pH-only events and a corresponding symptom sensitivity index, probably because of the lower milk intake, impaired esophageal motility, or a peculiar autonomic nervous system response pattern. There was no difference in morbidity due to GER or clinical characteristics of the two groups, irrespective of the presence of BPD (32).…”

Section: Discussionmentioning

confidence: 77%

Prevalence and Risk Factors for Gastroesophageal Reflux in Symptomatic Very Preterm Neonates

Hu¹,

Fu²,

Zhang³

2020

Preprint

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Background Because of immature development, preterm infants are prone to respiratory and digestive symptoms of dyspnea, vomiting, and aspiration pneumonia. These symptoms are often observed in infants with gastroesophageal reflux (GER). However, the relationship between GER and these symptoms remain unclear.Methods A cohort of 61 preterm infants born at 32 weeks of gestation or earlier with respiratory or digestive symptoms were retrospectively reviewed. All the preterm infants underwent 24-hour pH-multichannel intraluminal impedance monitoring. Clinical data were analyzed using logistic regression analyses.Results Among the 61 symptomatic preterm infants, 34 were positive for pathologic GER with a prevalence of 55.7%. The GER associated symptoms included apnea (42.6%), cyanosis (19.7%), vomiting (14.8%), pneumonia (9.8%), and poor weight gain (13.1%). These respiratory and digestive symptoms were more frequent in infants with pathologic GER than in those without. (p<0.05) The risk factors for GER included severe BPD (odds ratio [OR], 6.890; 95% confidence interval [CI], 1.125-42.209). Probiotics and delayed full oral feeds reduced the risk of GER (odds ratio [OR], 0.642; 95% confidence interval [CI], 0.457-0.901, p<0.05; OR, 0.234, 95% CI, 0.069-0.794, p<0.05). Conclusions The prevalence of GER is high in the symptomatic preterm infants. GER aggravates the respiratory and digestive symptoms holding that not all the symptoms are GER associated. Probiotics and delayed full oral feeds can decrease the prevalence of GER.

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“…30 Nobile and colleagues have suggested that impaired esophageal motility, and not GER, may be higher in infants with bronchopulmonary dysplasia (BPD). 31 They studied two groups of infants who were born at 32 weeks' gestational age that were showing symptoms of GER such as apnea, desaturations, bradycardia, and regurgitations near feedings. Twelve infants with BPD and 34 without respiratory disease were included, and none of the infants had surgeries or were on medications for GER.…”

Section: Comparison Of Breathing and Pharyngeal Swallowing Coordinatimentioning

confidence: 99%

Breathing and Swallowing: The Next Frontier

Gross

Trapani-Hanasewych

2017

Semin Speech Lang

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The anatomical overlap of the pathways for air passage and nutrition necessitate precise coordination between the two vital functions. Neuroanatomic structures in the brainstem for sucking, breathing, and swallowing are also in close proximity and must swiftly coordinate the processes. In a healthy neonate, the oropharyngeal experience and stimulation of early feeding enables respiratory control during suckling to develop. Despite wide variability among the methods used to investigate breathing and swallowing coordination in infancy, a consistent finding of postswallow exhalation has been reported. Postswallow exhalation is significant because the positive airflow of exhalation is believed to provide airway clearance. Preterm neonates and infants swallow during all phases of the respiratory cycle, but ultimately progress to the most commonly reported pattern, which is inhale-swallow-exhale. This pattern is similar to the adult pattern of exhale-swallow-exhale. Monitoring respiratory signals during nonnutritive sucking and early feeding may help to identify newborns with increased risk of aspiration and assist with clinical decision making.

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

Cited by 40 publications

References 37 publications

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

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

Prevalence and Risk Factors for Gastroesophageal Reflux in Symptomatic Very Preterm Neonates

Breathing and Swallowing: The Next Frontier

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