The effects of assisted autogenic drainage, combined or not with bouncing on gastroesophageal reflux in infants.

AIM: This study aimed to determine the effect of assisted autogenic drainage (AAD) with or without bouncing (BAAD) on both acid and non-acid gastroesophageal reflux (GER) in infants <1 year. METHODS: During a 24-h multichannel intraluminal impedance-pH monitoring (MII-pH), infants were treated with a 20-min intervention of AAD (in supine position) or BAAD (in upright position), 2 h postprandial. In this controlled trial with intra-subject design, the number of reflux episodes (REs) was the primary outcome measure. The results during AAD and BAAD were compared to a baseline period before intervention and 20 min after intervention. RESULTS: Overall, 50 infants were included in both groups. During AAD a significant decrease of RE's was found compared to baseline (p = 0.001). No significant differences were found in the BAAD group compared to baseline (p = 0.125). CONCLUSION: AAD and BAAD do not cause or increase GER in infants under the age of 1 year.

Prolonged Slow Expiration Technique and Gastroesophageal Reflux in Infants Under the Age of 1 Year.

Background: The Prolonged Slow Expiration Technique (PSE) is an airway clearance technique (ACT) carried out in newborn children with bronchial obstruction and hypersecretion to clear away the mucus from the respiratory tract. Evidence about the effect of PSE on gastroesophageal reflux (GER) is currently lacking in the literature. This study aimed to evaluate the influence of PSE on GER in infants under the age of 1 year. Methods: Infants were observed using multichannel intraluminal impedance-pH monitoring (MII-pH) over 24 h. During monitoring, the participants were treated with one 20 min intervention of PSE in supine position, 2 h after feeding. In this controlled trial with intra-subject design, the number of reflux episodes (REs) during PSE were compared to 20 min before and after PSE. Results: Fifty infants younger than 1 year were screened of whom 22 had a pathological GER. For the entire group, no significant difference was seen in the total number of REs between before, during, or after the PSE treatment (P = 0.76). No significant difference in total REs was found between the three measuring points (P = 0.59) in the group of infants with an abnormal MII-pH (n = 22). Conclusion: PSE does not cause a significant difference in REs in infants younger than 1 year. Registration number: NCT03341585.

Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis.

BACKGROUND: The optimal method to wean preterm infants from non-invasive respiratory support (NIVRS) with nasal continuous positive airway pressure (CPAP) or high-flow nasal cannula is still unclear, and methods used vary considerably between neonatal units. OBJECTIVE: Perform a systematic review and meta-analysis to determine the most effective strategy for weaning preterm infants born before 37 weeks' gestation from NIVRS. METHOD: EMBASE, MEDLINE, CINAHL, Google and Cochrane Central Register of Controlled Trials were searched for randomised controlled trials comparing different weaning strategies of NIVRS in infants born before 37 weeks' gestation. RESULTS: Fifteen trials (1.547 infants) were included. With gradual pressure wean, the relative risk of successful weaning at the first attempt was 1.30 (95% CI 0.93 to 1.83), as compared with sudden discontinuation. Infants were weaned at a later postmenstrual age (PMA) (median difference (MD) 0.93 weeks (95% CI 0.19 to 1.67)). A stepdown strategy to nasal cannula resulted in an almost 3-week reduction in the PMA at successful weaning (MD -2.70 (95% CI -3.87 to -1.52)) but was associated with a significantly longer duration of oxygen supplementation (MD 7.80 days (95% CI 5.31 to 10.28)). A strategy using interval training had no clinical benefits. None of the strategies had any effect on the risk of chronic lung disease or the duration of hospital stay. CONCLUSION: A strategy of gradual weaning of airway pressure might increase the chances of successful weaning. Stepdown strategy from CPAP to nasal cannula is a useful alternative resulting in an earlier weaning, but the focus should remain on continued weaning in order to avoid prolonged oxygen supplementation. Interval training should probably not be used.

The influence of Intrapulmonary percussive ventilation on gastroesophageal reflux in infants under the age of 1 year.

BACKGROUND: Intrapulmonary percussive ventilation (IPV) is an airway clearance technique used at any age to facilitate the removal of secretions from the respiratory tract. The effect of IPV on gastroesophageal reflux(GER) is not well documented. This study aimed to determine the influence of IPV on GER in infants. METHODS: During a 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH), infants in the intervention group received a20 minutes session of IPV in upright position, 2 hours postprandial. The control group received no intervention and was placed in the same position for 20 minutes, 2 hours postprandial. The number of reflux episodes (REs) during IPV as compared to the number of REs in the control group during the 20 minutes period. RESULTS: Fifty infants were included in each group;21 infants in the IPV group and 14 infants in the control group were diagnosed with abnormal MII-pH (P = .142). During IPV, the number of REs was significantly lower than in the control group (P < .001). Also in the subgroups with abnormal or normal MII-pH, a significantly lower number of REs during IPV was found (P = .011, P = .011 respectively). CONCLUSION: IPV decreases the number of REs in infants independent of the results of MII-pH.

Influence of bouncing and assisted autogenic drainage on acid gastro-oesophageal reflux in infants.

OBJECTIVES: To determine the influence of modern airway clearance techniques using assisted autogenic drainage (AAD), whether or not combined with bouncing, on acid gastro-oesophageal reflux (GOR) in infants <1 year. METHODS: In this controlled trial with intra-subject design infants were studied using oesophageal pH monitoring over 24 h, during which they received one 15 min session of bouncing, AAD or bouncing combined with AAD (BAAD). The number of reflux episodes (RE) and the refluxindex (RI) were the outcome measures. The results obtained during (T15) and 15 min after the intervention (T30) were compared to a period of 15 min before treatment (T0). RESULTS: The results of 150 infants, evenly distributed over the three treatment groups, were analyzed. No significant differences were found in number of RE at T15 and T30 compared to T0 in the bouncing group (P = 0.42), the AAD group (P = 0.14), and the BAAD group (P = 0.91). RI was significantly lower in the AAD group at T15 compared to T0 (P < 0.01). No differences in RI were found in the bouncing group (P = 0.28), nor in the BAAD group (P = 0.81). CONCLUSION: Bouncing, AAD and BAAD do not induce, nor aggravate acid GOR in infants under the age of 1 year.

Influence of respiratory physiotherapy on gastro-oesophageal reflux in infants: A systematic review.

PURPOSE: To provide a survey on the literature concerning the influence of respiratory physiotherapy on gastro-oesophageal reflux (GOR) in infants and young children. METHODS: Electronic databases (Pubmed, Web of Science, PEDro) and reference lists of articles and narrative reviews were searched. Articles were included when infants and small children underwent oesophageal pH monitoring or pH-multichannel intraluminal impedance monitoring while respiratory physiotherapy was administered. Descriptive analysis was performed and two researchers scored the methodological quality of these studies. RESULTS: Out of 985 articles, seven (six English, one French) have been included, In total 277 patients were involved, 71 with cystic fibrosis. Depending on the technique used, four studies showed GOR to be aggravated during therapy, three studies reported no effect. CONCLUSION: The evidence is not conclusive on whether respiratory physiotherapy induces or aggravates GOR in infants and small children. Age, disease, and treatment options play an important role. More specific research, also focussing on the influence of respiratory physiotherapy on non-acid reflux and the impact of recently developed airway clearance techniques (ACT's) on GOR is necessary.

Inhalation equipment hygiene: a belgian national survey.

BACKGROUND: Nebulizers are a potential source of contamination of the respiratory tract. Nevertheless, only a few clear guidelines regarding cleaning and disinfection of nebulizers are available. This survey aims to analyze the common household methods used by cystic fibrosis (CF) patients in Belgium. METHODS: A questionnaire about type of nebulizer, methods, and frequency of cleaning, disinfection, and drying was established by physiotherapists at the Belgian CF centers. RESULTS AND CONCLUSIONS: The Belgian CF Association sent this questionnaire to all Belgian CF patients. Of the 903 questionnaires distributed, 379 (42%) were returned. Fifty-two, 40 and 8% of patients used a vibrating-mesh nebulizer, jet nebulizer, or ultrasonic device, respectively. Ninety-eight percent of patients cleaned their material and soap was used by 35% of patients. Disinfection was performed by 91% of the patients and was daily performed by 57% of patients. Thermal disinfection (boiling water or sterilizer), a hypochlorite-based solution, or acetic acid solution was used by 44, 29, and 25% of patients, respectively, to disinfect their nebulizers. Thermal disinfection was used by 37 and 53% of patients using a classical or vibrating-mesh nebulizer, respectively. After cleaning or disinfection, 91% of the material was dried. The high percentage of Belgian CF patients disinfecting their nebulizer proves that they seem aware of the hygiene problem. The lack of unanimous guidelines in Belgium at the time of the study perhaps explains the variety of methods used. The arrival of vibrating-mesh nebulizers has led to a change in disinfection methods.

Influence of digital clubbing on oxygen saturation measurements by pulse-oximetry in cystic fibrosis patients.

OBJECTIVE: To determine the influence of digital clubbing on oxygen saturation by pulse oximetry measurements (SpO2) in Cystic Fibrosis patients. BACKGROUND: Measuring the arterial oxygen saturation at the fingertip by pulse-oximetry is commonly used in the management of CF patients. In these patients, clinical signs of hyperoxia are often observed with oxygen supplies based on digital oximetry readings. This suggests inaccuracies in the digital measurement method, which in its turn may be caused by digital clubbing. In order to study the influence of digital clubbing, measurements between fingertip and forehead sensor were compared in a clubbing and non-clubbing CF-population. The ear sensor measurements are used as a reference variable. METHODS: Two groups were examined. Group 1 consisted of 50 CF patients without digital clubbing (DPD/IPD ratio<1.00). Group 2 consisted of 50 CF patients with digital clubbing (DPD/IPD ratio>1.00). Patients were measured at rest before any treatment and with their daily oxygen supply, if applicable. Saturation was simultaneously measured with three Criticare SpO2 T pulse oximeters, using a fingertip sensor at the right index (transmission oximetry), a forehead sensor at the forehead (reflectance oximetry) and an ear sensor at the right ear. RESULTS: Using the Bland and Altman method no clear difference was found between the saturation measurements of right ear versus forehead sensor in the two groups. When the measurements of right ear versus fingertip sensor are compared there is still no difference for the non-clubbing group. On the contrary, for the clubbing group lower saturation scores were measured by the fingertip probe compared to the right ear measurement. The differences in saturation became greater as the saturation value at fingertip was lower. CONCLUSION: Digital clubbing significantly influences the registrations of the SpO2 measurements by means of a fingertip probe, underestimating the saturation. It can be advised to use the ear sensor as good alternative for these patients.