Elsevier

The Journal of Pediatrics

Volume 148, Issue 2, February 2006, Pages 265-268
The Journal of Pediatrics

Clinical and laboratory observation
Starch thickening of human milk is ineffective in reducing the gastroesophageal reflux in preterm infants: A crossover study using intraluminal impedance

https://doi.org/10.1016/j.jpeds.2005.09.034Get rights and content

We evaluated the efficacy of the thickening of human milk by precooked starch in reducing gastroesophageal reflux in preterm infants. Five preterm infants with frequent regurgitations (median gestational age, 28 weeks; range, 27 to 32 weeks; median birth weight, 990 g; range, 570 to 1900 g) were fed alternately during 24 hours with four meals of fortified maternal milk (milk A) and four meals of fortified maternal milk thickened by 1.5 g of precooked starch per 100 mL of milk (milk B). The acidic and buffered refluxes were detected by simultaneous pH monitoring and multiple intraluminal impedance. Eight feeding periods for each baby were recorded. The number of the acidic (34 after milk A vs 36 after milk B) and buffered (112 after milk A vs 134 after milk B) episodes of gastroesophageal reflux did not differ. Thickening human milk by precooked starch is ineffective in reducing gastroesophageal reflux in premature infants.

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Subjects

We designed a crossover study with a sample target of 14 patients; however, in view of the possible relation between milk thickening and the development of NEC recently described in two preterm infants,8 we did an interim analysis after five patients had been studied and stopped the study.

These five otherwise healthy preterm infants (three males; one small for gestational age) with frequent regurgitations were studied (Table I). None had malformations, major gastrointestinal problems,

Results

The procedure was well tolerated in all infants. All patients remained in a supine position after the meal. The quantities of milk ingested per feed by each infant are shown in Table I. The catheter remained in the fixed position in all cases. Three patients started the trial with milk A and two with milk B.

A total of 120 hours of tracing were recorded: 60 hours after nonthickened milk and 60 hours after thickened milk.

Only one patient of five showed a reduction of reflux with thickened milk (

Discussion

Preterm infants are at high risk for GER. The almost fixed supine position promotes the contact of the liquid gastric content with the gastroesophageal junction. In this condition, each transient relaxation of the lower esophageal sphincter leads to the entry of liquid into the esophagus. In addition, when the full enteral feeding is reached, the total fluid intake of preterm infants is particularly high (170 to 180 mL/kg per day), and the risk of GER increases. Finally, the frequent handling

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