Gastric emptying of milk in infants and children up to 5 years of age: normative data and influencing factors

Kwatra, Neha; Shalaby‐Rana, Eglal; Andrich, Mary P.; Tsai, Jason; Rice, Amy L.; Ghelani, Sunil J.; Spottswood, Stephanie E.; Majd, Massoud

doi:10.1007/s00247-020-04614-3

Cited by 27 publications

(30 citation statements)

References 16 publications

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“…Studies using scintigraphy to determine the rate of gastric emptying in healthy term infants have yielded inconsistent results. While some studies have reported faster gastric emptying in older infants, a large recent study found that infants less than 3 months of age have faster gastric emptying than older infants and children [17,18,19]. As expected, gastric emptying is twice as fast in infants fed breast milk compared to formula [20].…”

Section: Discussionmentioning

confidence: 66%

Ultrasound assessment of gastric emptying in premature infants treated with non-invasive ventilatory support

Kurepa¹,

Schanler²,

Weinberger³

et al. 2020

Preprint

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Background: Nasal CPAP introduces positive pressure of air into both trachea and stomach, which may affect gastric emptying. The rate of gastric emptying can be estimated by US by two validated techniques: “antral cross-sectional area” (2-dimensional estimate of the surface area at the gastric antrum), and “spheroid gastric volume” (3-dimensional estimate of the stomach content volume). No study examined gastric emptying rate in infants on bubble CPAP (bCPAP). Objective: To compare gastric emptying rates in neonates on machine-derived nasal CPAP (MD-nCPAP) with those on bCPAP. Methods: Ultrasound measurements of the amount of milk in the stomach were performed before feeding and at 1, 2, and 3 hours after the start of feeding, using both the ACSA and spheroid methods. Rates of gastric emptying were calculated during the “early” (1-2 hours) and “late” (2-3 hours) phases after feeding. Results: We recruited 32 infants (25-34 weeks gestational age). Seventeen infants were treated with MD-nCPAP [median birth weight 1015 g (IQR: 870 to 1300), gestational age 28 weeks (IQR: 27 to 29), postnatal age 20 days (IQR: 14 to 28)], while 15 infants were treated with bCPAP [median birth weight 960 g (IQR: 855 to 1070), gestational age 27 weeks (IQR: 26 to 28), postnatal age 17 days (IQR: 15 to 25)]. Gastric emptying rates (% emptied/min) were significantly faster in the “early” compared to the “late” phase for all infants. There were no significant differences in the rates of gastric emptying (either “early” or “late”) or volumes of gastric residuals between infants receiving MD-nCPAP or bCPAP, measured by either method. Conclusions: Gastric emptying is faster during the “early” compared to the “late” phase. Gastric emptying rates are not different in infants receiving MD-nCPAP vs bCPAP.

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Section: Discussionmentioning

confidence: 66%

Ultrasound assessment of gastric emptying in premature infants treated with non-invasive ventilatory support

Kurepa¹,

Schanler²,

Weinberger³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Вопрос, влияет ли задержка опорожнения желудка на исход фундопликации у детей с гастроэзофагеальной рефлюксной болезнью, остается по-прежнему спорным [1,4]. Некоторые исследования показывают, что частота рецидивов ГЭРБ после фундопликации выше у пациентов с задержкой опорожнения желудка, выявленной до операции [9][10][11].…”

Section: дискуссияunclassified

“…Нарушение опорожнения желудка у детей с гастроэзофагеальной рефлюксной болезнью (ГЭРБ) может наблюдаться как до, так и после фундопликации [1]. В его основе лежит гастропарез, причина которого по-прежнему остается неясной [2].…”

Section: Introductionunclassified

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Gastric peroral myotomy (G-POEM) in patients with delayed emptying function of the stomach

Kozlov

Смирнов

Kargabaeva

et al. 2020

Russian Journal of Pediatric Surgery

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Introduction. Disorders in the gastric evacuation function are met in patients with gastroesophageal reflux. In most cases, simultaneous laparoscopic pyloroplasty can solve the problem. As an alternative to surgical pyloroplasty to treat gastroparesis, a new technique has been proposed – peroral submucosal pyloromyotomy or gastric peroral endoscopic myotomy (G-POEM). Recently, this endoscopic surgery has been implemented in adults and in newborns with congenital hypertrophic pyloric stenosis to treat gastric paresis. In the present work, the authors describe this technique and short-term results after G-POEM in a child who had previously been operated on for gastroesophageal reflux.Material and methods. Peroral submucosal pyloromyotomy was performed in a girl of 5 y.o. with impaired motor-evacuation function of the stomach after surgical treatment of gastroesophageal reflux disease at the age of two . For 3 years, the child had therapy which included antiemetics and H2-receptor blockers. However, clinical symptoms constantly recurred, and it was decided to make a thorough examination of the patient. At the contrast examination of upper gastrointestinal tract, stomach enlargement and slow transit of the contrast preparation into the duodenum were seen. Fibrogastroduodenoscopy confirmed the normal function of the fundoplication cuff and found a cause of impaired gastric emptying. A contracted gastric outlet as a spasmodic pylorus was found to be an obstacle for normal stomach evacuation function. A narrow hole in the pylorus was found. A 5.4 mm gastroscope could pass through it. The patient had a complete peroral endoscopic submucosal pyloromyotomy. The technique of this surgery consisted in creating a submucosal tunnel at 4 cm before the pylorus and in dissecting the hypertrophied muscle layer by Ramstedt incision using an electrocoagulation knife. After the end of surgery, the incision on the mucous layer was closed with special clamps.Results. Surgical time lasted for 45 minutes. There were no intraoperative complications: bleedings and mucosal perforation . The patient began to eat in 6 hours after the surgery. The transition to full enteral feeding lasted for 24 hours. The child was discharged from the hospital next day in good condition. At the follow-up examination 6 months after surgery, the girl had weight and height typical for her age. There were no signs of dysphagia, abdominal distension, nausea and vomiting any more . There were no post-operative scarring on the child’s abdominal wall.Conclusion. Peroral submucosal pyloromyotomy is technically implementable, safe and effective for treating disorders of stomach evacuation function in children. Further research is needed to find the place of this technique in the treatment of gastric outlet obstruction.

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Effect of blenderized tube feeds on gastric emptying: A retrospective cohort study

Hron

Voss

et al. 2023

J Parenter Enteral Nutr

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Background Blenderized tube feeds (blends) are associated with lower hospital admissions and reduced gastroesophageal symptoms, but their high viscosity may theoretically prolong gastric emptying. Our objective was to compare differences in gastric emptying with blends vs with formula. Methods We retrospectively identified individuals 6 months to 20 years with enteral tubes who underwent 1‐h liquid gastric emptying scintigraphy from 1998 to 2020 at Boston Children's Hospital. Examinations were excluded if a postpyloric tube was present, tracer was administered orally or with diet differing from habitual, habitual diet was indeterminable, imaging was terminated early, or >50% of input counts emptied during bolus administration. Emptying was classified as delayed if gastric residual at 1 h was ≥60% of ingested dose. Results Eighteen examinations (15 individuals) were performed with blends and 35 examinations (32 individuals) with formula. Although percentage of residual at 1 h was significantly higher in patients receiving blends compared with formula (54 ± 17 vs 40 ± 25, P = 0.04), the number of patients with delayed gastric emptying did not differ (39% vs 29%, respectively, P = 0.54). Type of diet, feed volume or concurrent medications did not predict delayed gastric emptying. Children with blends received higher bolus volumes (106 ± 55 vs 66 ± 59 ml; P = 0.02), and this significantly predicted percentage of residual (β = 0.14; P = 0.01). Conclusion The proportion of patients with delayed gastric emptying was similar in children receiving blends and formula. Although the mean percentage of gastric residual was higher with blends, this may be explained by higher bolus volumes administered. This preliminary work suggests that blends compare favorably to formula.

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Gastric emptying of milk in infants and children up to 5 years of age: normative data and influencing factors

Cited by 27 publications

References 16 publications

Ultrasound assessment of gastric emptying in premature infants treated with non-invasive ventilatory support

Ultrasound assessment of gastric emptying in premature infants treated with non-invasive ventilatory support

Gastric peroral myotomy (G-POEM) in patients with delayed emptying function of the stomach

Effect of blenderized tube feeds on gastric emptying: A retrospective cohort study

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