Gastro-oesophageal reflux in preterm infants.

Newell, S J; Booth, I W; Morgan, M. E. I.; Durbin, G M; McNeish, A S

doi:10.1136/adc.64.6.780

Cited by 117 publications

(67 citation statements)

References 23 publications

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“…GOR on its own is a well-acknowledged risk factor for pulmonary complications like aspiration pneumonia, laryngo-and bronchospasm and apnoea [7][8][9]. Routine oesophageal pH monitoring has therefore been recommended when methylxanthines are administered to young infants [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of Cisapride on Acid Gastro-Oesophageal Reflux during Treatment with Caffeine

Kentrup¹,

Baisch²,

Kusenbach³

et al. 2000

Neonatology

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About 50% of preterm infants and neonates receiving methylxanthines for respiratory stimulation will develop a pathological gastro-oesophageal reflux (GOR) pattern. In the face of potential GOR-related complications the effect of a concomitant treatment with a prokinetic agent, such as cisapride, should be evaluated. In this study 32 formerly preterm infants were studied simultaneously by 24-hour oesophageal pH monitoring and cardio-respirogram before the presumed end of caffeine treatment. In 14 of these infants a reflux index (RI; percentage of recording time) of more than 4% could be detected (pH <4). Ten of them were treated orally with cisapride (0.2 mg/kg t.i.d.). Data of pH monitoring, cardio-respirogram and caffeine serum concentrations were obtained before and 5 days after introducing cisapride. The RI and the frequency of GOR decreased significantly with cisapride. The steady-state serum concentrations of caffeine were not influenced by cisapride and the extent of periodic breathing remained unchanged. In conclusion, cisapride has a positive influence on GOR parameters during caffeine treatment without impairing the oral bioavailability or therapeutic effect of caffeine.

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Section: Introductionmentioning

confidence: 99%

Effect of Cisapride on Acid Gastro-Oesophageal Reflux during Treatment with Caffeine

Kentrup¹,

Baisch²,

Kusenbach³

et al. 2000

Neonatology

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“…No significant differences were found in the proportions of infants who had apnea between those with and without GER (10). Most other studies have also failed to document a temporal relationship between apnea and GER (17)(18)(19)(20)(21)(22)(23). We now highlight that there is no such relationship in either the prone or, importantly, the supine position in convalescent, prematurely born infants.…”

Section: Discussionmentioning

confidence: 81%

Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea

et al. 2007

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Concerns regarding gastroesophageal reflux (GER) and associated apnea episodes result in some practitioners having convalescent, prematurely born infants sleep in the prone position. We have tested the hypothesis that such infants would not suffer from clinically important acid GER or associated apnea episodes more in the supine compared with the prone position. Lower esophageal pH was measured and videopolysomnographic recordings of nasal airflow, chest and abdominal wall movements, electrocardiographic activity, and oxygen saturation were made on two successive days of 21 premature infants (median gestational age 28 wk) at a median postmenstrual age (PMA) of 36 wk. On each day, the infants were studied prone and supine. The acid reflux index was higher in the supine compared with the prone position (median 3% versus 0%, p ϭ 0.002), but was low in both positions. The number of obstructive apnea episodes per hour was higher in the supine position (p ϭ 0.008). There were, however, no statistically significant correlations between the amount of acid GER and the number of either obstructive or total apnea episodes in either the supine or prone position. Supine compared with prone sleeping neither increases clinically important acid GER nor obstructive apnea episodes associated with acid GER in asymptomatic, convalescent, prematurely born infants. (Pediatr Res 62: 620-623, 2007) P rematurely born infants are at increased risk of sudden infant death syndrome (SIDS), particularly if they sleep in the prone position (1). Despite this known adverse association, some prematurely born infants still sleep in the prone position at the age when they are at highest risk of SIDS (2). Several studies have highlighted that parents are strongly influenced by health care practitioners with regard to their choice of sleeping position for their infant (3,4). Worryingly, the results of a national survey (5) revealed that in some neonatal units, prematurely born infants slept in the prone position even just before discharge from the neonatal intensive care unit (NICU). One of the reasons given for continuation of prone sleeping is the perceived increased risk of gastroesophageal reflux (GER) in the supine position (6) and that the likelihood of associated problems such as apnea may be less in the prone position. Yet, it is known that there is maturation of the reflexes that protect against GER and esophagopharyngeal reflux (7). Esophageal and upper esophageal sphincter motor responses to abrupt mid-esophageal provocation are present as early as 33 wk PMA, and the response characteristics improve during development (7). We, therefore, hypothesized that convalescent, asymptomatic, prematurely born infants ready for NICU discharge would not suffer from either clinically important acid GER or apnea episodes associated with acid GER more in the supine compared with the prone position. The aim of this study was to test that hypothesis by investigating the influence of sleeping position on acid reflux and any association with apnea...

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“…Enquanto este esfíncter resiste a pressão de 4 mmHg com 27-28 semanas, chega a 18 mmHg a termo 16 . Esta pressão é pouco reduzida pela sonda oro-gástrica e muito reduzida por cafeína 17 . Este fato leva freqüentemente a refluxo gástrico-esofágico com toda a sua sintomatologia (vômitos, esofagite, apnéia recorrente, aspiração pulmonar, piora da displasia pulmonar, dificuldade de crescimento).…”

Section: Desenvolvimento Do Trato-intestinalunclassified

“…Este fato leva freqüentemente a refluxo gástrico-esofágico com toda a sua sintomatologia (vômitos, esofagite, apnéia recorrente, aspiração pulmonar, piora da displasia pulmonar, dificuldade de crescimento). Frente a pré-termos com os sintomas listados, deve-se sempre pensar na possibilidade de refluxo 17 .…”

Section: Desenvolvimento Do Trato-intestinalunclassified

Nutrition of the preterm infants

Martinez¹,

Camelo²

2001

J Pediatr (Rio J)

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Objective: to review the recent medical literature on nutrition of preterm infants, focusing on practical aspects that are relevant to pediatricians and neonatologists.Sources: an extensive review of the related literature using Medline, Cochrane Database of Systematic Reviews and Best Evidence was performed.Summary of the findings: there is compelling evidence that early nutritional practices may affect short-term growth and developmental outcome in preterm infants. In addition, these practices have a determinant role in adult health. We still have to learn a lot about the safety and effectiveness of nutrient administration in preterm infants; about techniques targeted at assessing the effect of different nutritional strategies; and about the long term effects of these regimens on developmental outcome, growth and disease.Conclusions: despite recent advances in neonatal nutrition, basic and clinical research is still necessary so that the nutritional needs of preterm infants can be better defined and adequately provided.J Pediatr (Rio J) 2001; 77 (Supl.1): S32-S40: parenteral nutrition, enteral nutrition, nutrition, human milk, prematurity, protein, lipids, calories. ResumoObjetivo: rever a literatura atual sobre a alimentação do recém-nascido pré-termo, enfocando os aspectos práticos relevantes para pediatras e neonatologistas.Método: foi realizada revisão bibliográfica utilizando os bancos de dados Medline, Cochrane Database of Systematic Reviews e Best Evidence.Resultado: cada vez mais fica evidente que as práticas alimentares estabelecidas com os pré-termos podem afetar não só o desenvolvimento imediato, mas também sua evolução a longo prazo. A nutrição neste período pode determinar se o adulto será mais o menos saudável. Existe um longo caminho de aprendizado sobre a segurança e eficácia dos nutrientes administrados para os pré-termos, sobre as técnicas para avaliar as diferentes estratégias alimentares e sobre os efeitos em longo prazo destes regimes no desenvolvimento, crescimento e aparecimento de doenças.Conclusão: apesar dos grandes avanços na área, ainda são necessários estudos básicos e clínicos para aprofundar a compreensão das necessidades nutricionais do recém-nascido pré-termo e da forma mais adequada de supri-las.J Pediatr (Rio J) 2001; 77 (Supl. Introdução O nascimento de uma criança pré-termo representa uma urgência nutricional. Cálculos teóricos demonstram que estas crianças apresentam reservas nutricionais de poucos dias 1 e quanto menor o tamanho ao nascer, menor esta reserva. As crianças nascidas com 24 semanas chegam a possuir apenas 1 dia de reserva calórica 2 . Os pré-termos com menos de 1.000g, mesmo com a alimentação parenteral iniciada no primeiro dia, chegam a perder 10% de seu peso e demoram cerca de 11 dias para recuperar o peso de nascimento 3 .O manejo nutricional do pré-termo é uma área cheia de controvérsias, especialmente pela falta de estudos randomizados e controlados 4 . Os conhecimentos ficam ainda mais esparsos quando se trata de pré-termos doentes. A enorme var...

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Gastro-oesophageal reflux in preterm infants.

Cited by 117 publications

References 23 publications

Effect of Cisapride on Acid Gastro-Oesophageal Reflux during Treatment with Caffeine

Effect of Cisapride on Acid Gastro-Oesophageal Reflux during Treatment with Caffeine

Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea

Nutrition of the preterm infants

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