Effect of feed temperature and phototherapy on gastric emptying in the neonate.

Abstract

suMMARY The effect of feed temperature and phototherapy on the rate of stomach emptying was studied in healthy infants during the first week. Emptying rate was measured by the modified serial test meal technique using 10 % Dextrose feeds. The results show that emptying rate is independent of feed temperature and is not affected by phototherapy.In many nurseries, feeds are refrigerated after preparation and then are heated before they are given to the newborn infant. This practice is based more on custom than on reason since it has been shown that refrigerated feeds are well tolerated.1 Also, it is said that stomach emptying is more rapid when feeds of low temperature are given.2 The fact that small infants are likely to regurgitate and aspirate their gastric contents prompted us to study the effect of feed temperature on stomach emptying.It has been our impression that newborn infants often develop abdominal distension during phototherapy and only recently has this been studied.3 Based on the assumption that such distension is caused by gastric retention, we studied the effect of phototherapy on the rate of stomach emptying. Patients and methodsTest meals of three different temperatures: cold (0-40C), room temperature (about 250C), and body temperature (370C) were given during the first week to 20 healthy infants. Mean (± SE) birthweight was 1 * 97 ± O 06 (range 1 *55-2*53) kg, and gestation 35 6 ± 0 4 (range 32-39) weeks. Meals were given over a period of 24 hours. Temperature sequence was varied to obtain a balanced distribution and the volume retained at each temperature was compared.Cold test meals (0-40C) were given on day 3 or 4 to 12 healthy infants with jaundice (mean ± SE bilirubin 227 + 20 9 rmol/l; 13 *3 + 1 *2 mg/100ml).Mean (± SE) birthweight was 2 75 ± 0-18 (range 1.49-3.38) kg, and gestation 37-7 ± 0.6 (range 34-41) weeks. After a period of continuous phototherapy ranging between 16 and 24 hours, meals were again given and the differences in gastric retention before and after phototherapy were compared.Stomach emptying was measured by the modified serial test meal technique.4 Test meals of 10 % Dextrose containing phenol red (0.12 mg/100 ml) were given by tube Ij to 3 hours after the last feed. After first washing out the stomach, 20 ml test feed was given over 1 to 3 minutes and the infant was placed in the prone position. 30 minutes later the stomach was emptied and the aspirate volume recorded. The stomach was then washed out with 20 ml sterile water. The true volume remaining was calculated by the following formula: Volume retained = aA + 20B/c, where a is the volume of the aspirate after 30 minutes, A optical density of the aspirate, B optical density of washout, and c optical density of test meal.Aliquots of A, B, and c were alkalinised with trisodium orthophosphate (pH 12) before measurement in a spectrophotometer at wavelength 560 nm. In order to satisfy fluid requirements and prevent hypoglycaemia infants were given milk feeds at the end ofeach study.Approval for the study was obtained fr...

Effects of Jaundice and Phototherapy on Gastric Emptying in the Newborn

“…Our findings confirm that phototherapy per se has no effect on gas tric emptying, but, whereas gastric emptying before phototherapy did not differ from nor mal in the patients of Blumenthal et al [9], in our more severly jaundiced infants gastric emptying was impaired, and returned to nor mal if phototherapy successfully reduced the serum bilirubin concentration. In the 3 cases in whom phototherapy failed to improve gas tric emptying, the serum bilirubin either failed to respond or was not particularly high before phototherapy.…”

“…The only previous report on this subject [9] showed that phototherapy had no effect on gastric emptying, but most of the patients investigated had mild jaundice by our stan dards (mean serum bilirubin concentration 227 pmol/1 SE ± 20.9), a constant-volume test feed was used for infants weighing 1,490-3,380 g and the test feed was 10% dextrose, a solution known to inhibit gastric emptying in the newborn [6,17,18]. Our findings confirm that phototherapy per se has no effect on gas tric emptying, but, whereas gastric emptying before phototherapy did not differ from nor mal in the patients of Blumenthal et al [9], in our more severly jaundiced infants gastric emptying was impaired, and returned to nor mal if phototherapy successfully reduced the serum bilirubin concentration.…”

“…The test meal was given by tube at room temperature (feed temperature has no apparent effect on gastric emptying [8,9] in a volume of 20 ml/kg given 3.5 h after the last routine feed. 30 min later the gastric contents were aspirated and the stomach washed out to recover any remain ing part of the feed.…”

Neither Motor Responses nor Gastric Emptying Vary in Response to Formula Temperature in Preterm Infants

“…Interpretation of this was significantly limited by the small numbers of infants studied, such that some study groups contained only 1 or 2 infants. The results of the study performed by Gonzales et al [21] are contrasted by those found by Blumenthal et al [22] and Costalos et al [23]. Both these groups, using repeated-measures designs in 20 and 31 preterm infants, respectively, reported that gastric emptying did not differ when pre term infants were fed formulas at varying temperatures ranging from 4 to 37°C.…”

Warming Infant Feeds: What is the Evidence and What are the Questions?

“…al. 16 included 20 patients in a crossover design with gestational age 32 to 39 weeks. In this case, feeds were 10% dextrose and were again fed at three temperatures.…”