Abstract
Objectives
Gastroesophageal reflux may exacerbate chronic lung disease in preterm infants. We evaluated the short-term effects of transpyloric feeding on respiratory status in preterm infants during mechanical ventilation.
Methods
We retrospectively collected data from the hospital information management system. To evaluate the effect of transpyloric feeding on oxygenation, we compared changes in SpO2/FiO2 ratios before and after commencing transpyloric feeding by a piecewise linear regression model.
Results
We examined 33 infants (median gestational age, 25.4 weeks; median birth weight, 656 g) who underwent transpyloric feeding. All tubes were placed at the bedside without fluoroscopy. No cases of unsuccessful placement, gastroduodenal perforation, or tracheal misinsertion occurred. Transpyloric feeding began at a median age of 18 (interquartile range, 15–23) days. Mean SpO2/FiO2 (±SD) ratios were 391 (±49), 371 (±51), 365 (±56), and 366 (±53) 72–96 h before, 0–24 h before, 48–72 h after, and 96–120 h after starting transpyloric feeding, respectively. The rate of change per hour of SpO2/FiO2 ratios increased 48–120 h after compared with 0–96 h before transpyloric feeding (0.03 [95% confidence interval, −0.10 to 0.17] vs. −0.29 [−0.47 to −0.12]) (p=0.007). No apparent changes occurred in the mean airway pressure, amplitude pressure, or pCO2.
Conclusions
Transpyloric feeding during mechanical ventilation can prevent the deterioration of oxygenation without major complications at the stage of respiratory exacerbation in preterm infants.
Acknowledgments
We thank Hugh McGonigle, from Edanz Group (www.edanzediting.com/ac), for editing a draft of the manuscript.
-
Research funding: None declared.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Informed consent was obtained from all individuals included in this study.
-
Ethical approval: This study was approved by the institutional review board of Kanagawa Children’s Medical Center (No. 1807–8, 4 February 2019).
References
1. Jolley, SG, Herbst, JJ, Johnson, DG, Matlak, ME, Book, LS. Esophageal pH monitoring during sleep identifies children with respiratory symptoms from gastroesophageal reflux. Gastroenterology 1981;80:1501–6. https://doi.org/10.1016/0016-5085(81)90264-x.Search in Google Scholar
2. Farhath, S, He, Z, Nakhla, T, Saslow, J, Soundar, S, Camacho, J, et al.. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics 2008;121:e253–9. https://doi.org/10.1542/peds.2007-0056.Search in Google Scholar PubMed
3. Akinola, E, Rosenkrantz, TS, Pappagallo, M, McKay, K, Hussain, N. Gastroesophageal reflux in infants < 32 weeks gestational age at birth: lack of relationship to chronic lung disease. Am J Perinatol 2004;21:57–62. https://doi.org/10.1055/s-2004-820512.Search in Google Scholar PubMed
4. Omari, TI, Barnett, CP, Benninga, MA, Lontis, R, Goodchild, L, Haslam, RR, et al.. Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease. Gut 2002;51:475–9. https://doi.org/10.1136/gut.51.4.475.Search in Google Scholar PubMed PubMed Central
5. Nobile, S, Noviello, C, Cobellis, G, Carnielli, VP. Are infants with bronchopulmonary dysplasia prone to gastroesophageal reflux? A prospective observational study with esophageal pH-impedance monitoring. J Pediatr 2015;167:279–85. https://doi.org/10.1016/j.jpeds.2015.05.005.Search in Google Scholar PubMed
6. Singer, P, Blaser, AR, Berger, MM, Alhazzani, W, Calder, PC, Casaer, MP, et al.. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38:48–79. https://doi.org/10.1016/j.clnu.2018.08.037.Search in Google Scholar PubMed
7. Li, Z, Qi, J, Zhao, X, Lin, Y, Zhao, S, Zhang, Z, et al.. Risk-benefit profile of gastric vs transpyloric feeding in mechanically ventilated patients: a meta-analysis. Nutr Clin Pract 2016;31:91–8. https://doi.org/10.1177/0884533615595593.Search in Google Scholar PubMed
8. Eichenwald, EC. Diagnosis and management of gastroesophageal reflux in preterm infants. Pediatrics 2018;142:e20181061. https://doi.org/10.1542/peds.2018-1061.Search in Google Scholar PubMed
9. Meert, KL, Daphtary, KM, Metheny, NA. Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: a randomized controlled trial. Chest 2004;126:872–8. https://doi.org/10.1378/chest.126.3.872.Search in Google Scholar PubMed
10. Watson, J, McGuire, W. Transpyloric versus gastric tube feeding for preterm infants. Cochrane Database Syst Rev 2013;2:CD003487. doi:https://doi.org/10.1002/14651858.CD003487.pub3.Search in Google Scholar PubMed PubMed Central
11. Malcolm, WF, Smith, PB, Mears, S, Goldberg, RN, Cotten, CM. Transpyloric tube feeding in very low birthweight infants with suspected gastroesophageal reflux: impact on apnea and bradycardia. J Perinatol 2009;29:372–5. https://doi.org/10.1038/jp.2008.234.Search in Google Scholar PubMed PubMed Central
12. Misra, S, Macwan, K, Albert, V. Transpyloric feeding in gastroesophageal-reflux-associated apnea in premature infants. Acta Paediatr 2007;96:1426–9. https://doi.org/10.1111/j.1651-2227.2007.00442.x.Search in Google Scholar PubMed
13. Tanaka, S. Nationwide surveillance of transpyloric feeding for neonatal chronic lung disease (CLD). J Jpn Soc Premat Newborn Med 2007;19:3. (Article in Japanese Abstract).Search in Google Scholar
14. Mandell, LA, Niederman, MS. Aspiration pneumonia. N Engl J Med 2019;380:651–63. https://doi.org/10.1056/nejmra1714562.Search in Google Scholar
15. Khemani, RG, Patel, NR, Bart, RD3rd, Newth, CJL. Comparison of the pulse oximetric saturation/fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest 2009;135:662–8. https://doi.org/10.1378/chest.08-2239.Search in Google Scholar PubMed
16. Prieto, CL, Colomer, BF, Sastre, JB. Prognostic factors of mortality in very low-birth-weight infants with neonatal sepsis of nosocomial origin. Am J Perinatol 2013;30:353–8. https://doi.org/10.1055/s-0032-1324701.Search in Google Scholar PubMed
17. Flores, JC, Lopez-Herce, J, Sola, I, Carrillo, AJr. Duodenal perforation caused by a transpyloric tube in a critically ill infant. Nutrition 2006;22:209–12. https://doi.org/10.1016/j.nut.2005.08.005.Search in Google Scholar PubMed
18. Chellis, MJ, Sanders, SV, Dean, JM, Jackson, D. Bedside transpyloric tube placement in the pediatric intensive care unit. J Parenter Enteral Nutr 1996;20:88–90. https://doi.org/10.1177/014860719602000188.Search in Google Scholar PubMed
19. Phipps, LM, Weber, MD, Ginder, BR, Hulse, MA, Thomas, NJ. A randomized controlled trial comparing three different techniques of nasojejunal feeding tube placement in critically ill children. J Parenter Enteral Nutr 2005;29:420–4. https://doi.org/10.1177/0148607105029006420.Search in Google Scholar PubMed
20. Agostoni, C, Buonocore, G, Carnielli, VP, De Curtis, M, Darmaun, D, Decsi, T, et al.. Enteral nutrient supply for preterm infants: commentary from the European society of paediatric Gastroenterology, Hepatology and nutrition committee on nutrition. J Pediatr Gastroenterol Nutr 2010;50:85–91. https://doi.org/10.1097/mpg.0b013e3181adaee0.Search in Google Scholar PubMed
21. Aceti, A, Corvaglia, L, Paoletti, V, Mariani, E, Ancora, G, Galletti, S, et al.. Protein content and fortification of human milk influence gastroesophageal reflux in preterm infants. J Pediatr Gastroenterol Nutr 2009;49:613–8. https://doi.org/10.1097/mpg.0b013e31819c0ce5.Search in Google Scholar
© 2020 Walter de Gruyter GmbH, Berlin/Boston