scholarly journals Transpiloric feeding in gastroesophageal reflux in neonatology

2021 ◽  
Vol 12 (4) ◽  
pp. 59-67
Author(s):  
O. G. Smirnov ◽  
V. I. Gorbachev ◽  
N. G. Aleinikova
Keyword(s):  
Gastroesophageal Reflux ◽  
Enteral Nutrition ◽  
Preterm Infants ◽  
Feeding Tube ◽  
Critically Ill Children ◽  
First Line Therapy ◽  
Clinical Complications ◽  
Premature Babies ◽  
Iatrogenic Complications ◽  
Seriously Ill

Optimizing nutritional support is essential for critically ill children, and premature infants are particularly vulnerable to the effects of prolonged fasting. There is a lot of evidence in the scientific literature for the benefits of enteral nutrition. It is known that premature babies need an individual approach to nutrition due to the prevalence of catabolic processes, while treatment in the intensive care unit requires a surplus of calories. Timely introduction of enteral nutrition helps to reduce morbidity and mortality in this population. Gastroesophageal reflux is common in preterm infants. When there is a decrease in tolerance to enteral feeding, doctors usually prefer parenteral nutrition. However, its use can be associated with metabolic, infectious and iatrogenic complications. A step-by-step therapeutic approach is recommended in the treatment of GER in preterm infants. Conservative treatment should be considered as first-line therapy in children without clinical complications. Feeding through a gastric tube is not always well tolerated by seriously ill people patients. As for the treatment of complicated GER, extensive studies show that the use of transpiloric feeding is comparable in effectiveness to fundoplication. Transpiloric feeding tube can be justified as a strategy for treating GER that is refractory to conservative therapy.

Nasogastric Feeding Tubes May Not Contribute to Gastroesophageal Reflux in Preterm Infants

2017 ◽  
Vol 35 (07) ◽  
pp. 643-647 ◽  
Author(s):  
Swati Murthy ◽  
Apryle Funderburk ◽  
Sheeja Abraham ◽  
Michele Epstein ◽  
Joan DiPalma ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Preterm Infants ◽  
Ph Monitoring ◽  
Feeding Tube ◽  
Acid Exposure ◽  
Total Fluid Intake ◽  
Nasogastric Feeding ◽  
Intraluminal Impedance ◽  
Significant Difference ◽  
Acid Exposure Time

Objective The objective was to determine if the presence of a nasogastric (NG) feeding tube is associated with increased gastroesophageal reflux (GER) and acid exposure in preterm infants. Study Design This is a retrospective study on preterm infants [gestational age (GA) <37 weeks] who were evaluated by multichannel intraluminal impedance and pH monitoring (MII-pH) between October 2009 and March 2016. Infants were divided into two groups, NG tube present and no feeding tube. GER events per hour and the percent of time with pH <4 during a 24-hour period were then compared. Results Eighty-three infants were included, 41 had an NG tube present and 42 did not. The group without an NG tube had significantly more reflux events per hour (2.3 ± 2.9 vs. 1.3 ± 0.8, p < 0.05) even after adjusting for differences in birth weight, GA, corrected GA, and total fluid intake. There was no significant difference in acidic events per hour and acid exposure time between the two groups. Conclusion The presence of a 5-French NG tube is not associated with an increase in GER or acid exposure in preterm infants. In fact, it appears that infants fed through an NG tube have fewer episodes of GER.

scholarly journals Pharmacological Therapy of Gastroesophageal Reflux in Preterm Infants

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Luigi Corvaglia ◽  
Caterina Monari ◽  
Silvia Martini ◽  
Arianna Aceti ◽  
Giacomo Faldella
Keyword(s):  
Gastroesophageal Reflux ◽  
Adverse Effects ◽  
Preterm Infants ◽  
State Of The Art ◽  
Pharmacological Therapy ◽  
Common Phenomenon ◽  
Pharmacological Management ◽  
Clinical Complications ◽  
Increased Risk ◽  
Receptor Blockers

Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER’s improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.

scholarly journals Sensory Stimulation in the NICU Environment: Devices, Systems, and Procedures to Protect and Stimulate Premature Babies

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 334
Author(s):  
Francesco Massimo Vitale ◽  
Gaetano Chirico ◽  
Carmen Lentini
Keyword(s):  
Music Therapy ◽  
Preterm Infants ◽  
Noise Pollution ◽  
Sensory Stimulation ◽  
Normative Values ◽  
Control Groups ◽  
Beneficial Effects ◽  
Stressful Environment ◽  
Premature Babies ◽  
Systematic Control

Prematurity deprives infants of the prenatal sensory stimulation essential to their correct development; in addition, the stressful environment of the NICU impacts negatively on their growth. The purpose of this review was to investigate the effects of NICU noise pollution on preterm infants and parents. We focused on the systems and projects used to control and modulate sounds, as well as on those special devices and innovative systems used to deliver maternal sounds and vibrations to this population. The results showed beneficial effects on the preterm infants in different areas such as physiological, autonomic, and neurobehavioral development. Although most of these studies highlight positive reactions, there is also a general acknowledgement of the current limits: small and heterogeneous groups, lack of structured variable measurements, systematic control groups, longitudinal studies, and normative values. The mother’s presence is always preferred, but the use of music therapy and the devices analyzed, although not able to replace her presence, aim to soften her absence through familiar and protective stimuli, which is a very powerful aid during the COVID-19 pandemic.

scholarly journals Gastroesophageal Reflux in Critically Ill Children: A Review

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Maria José Solana García ◽  
Jesús López-Herce Cid ◽  
César Sánchez Sánchez
Keyword(s):  
Gastroesophageal Reflux ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Esophageal Mucosa ◽  
Duration Of Action ◽  
Nasogastric Tubes ◽  
Intraluminal Impedance ◽  
High Incidence ◽  
Antireflux Barrier ◽  
Ph Metry

Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile.

Gastroesophageal Reflux and Prokinetic Agents

2005 ◽  
Vol 24 (2) ◽  
pp. 51-58 ◽  
Author(s):  
Davita Hammer
Keyword(s):  
Weight Gain ◽  
Gastroesophageal Reflux ◽  
Lower Esophageal Sphincter ◽  
Preterm Infants ◽  
Aspiration Pneumonia ◽  
Main Mechanism ◽  
Term Infants ◽  
Gastric Contents ◽  
Esophageal Sphincter ◽  
Poor Weight Gain

GASTROESOPHAGEAL REFLUX (GER), a common problem in preterm and term infants, occurs when there is retrograde movement of gastric contents into the esophagus. The severity of the reflux is related to the height of the gastric contents up into the esophagus or the oral pharynx. Transient lower esophageal sphincter relaxation is the main mechanism thought to be responsible for GER in infants.1–3In a study conducted by Marino and associates, approximately 60 percent of preterm infants were affected by reflux.4GER is associated with irritability, apnea and bradycardia, poor weight gain, aspiration pneumonia, and esophagitis.2,5–7

scholarly journals Antacid therapy for gastroesophageal reflux in preterm infants: a systematic review

2018 ◽  
Vol 2 (1) ◽  
pp. e000287 ◽  
Author(s):  
Elda Dermyshi ◽  
Charley Mackie ◽  
Phoebe Kigozi ◽  
Bernard Schoonakker ◽  
Jon Dorling
Keyword(s):  
Systematic Review ◽  
Gastroesophageal Reflux ◽  
Preterm Infants ◽  
Antacid Therapy
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