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

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.

Temporal Association Between Reflux-like Behaviors and Gastroesophageal Reflux in Preterm and Term Infants.

OBJECTIVES: Multichannel intraluminal impedance studies (MII-pH) have become the criterion standard for the diagnosis of gastroesophageal reflux (GER). Several clinical signs and symptoms that are attributed to GER during infancy may not be related to true reflux. Our objective was to correlate the observed reflux-like behaviors to reflux events on MII-pH studies. METHODS: This is a retrospective study on infants being evaluated for GER with MII. During the MII-pH study, the infants were observed for clinical behaviors. Symptom Index (SI), symptom sensitivity index (SSI), and symptom association probability were used to correlate symptoms with reflux events. RESULTS: Of 58 infants (40 preterm, 18 term) included in the study, only 6 infants (10%) had an abnormal MII-pH study. Irritability (32 infants), bradycardia (20), and desaturation (18) were the common signs and symptoms. A total of 2142 (755 acidic and 1386 nonacidic) reflux episodes and 953 clinical reflux behaviors were recorded. The incidence and pattern of GER was similar in preterm and term infants. There was no significant difference in GER episodes and acid exposure in preterm infants fed orally or via nasogastric tube. The symptom association probability was abnormal in only 6 (19%), 1 (5%), and 5 (28%) infants with irritability, bradycardia, and desaturation, respectively. CONCLUSIONS: The prevalence of GER as detected by MII-pH was low (10%) in symptomatic preterm and term infants. The incidence and pattern of GER was similar in preterm and term infants. The majority of suspected clinical reflux behaviors did not correlate with reflux events.

Prolonging gavage feeds for reduction of gastroesophageal reflux in infants.

OBJECTIVE: To determine if prolonging gavage feedings in infants for ≥60 min is associated with decreased gastroesophageal reflux (GER) compared with bolus feeding using multiple-channel intraluminal impedance with pH probe (MII-pH). STUDY DESIGN: Retrospective analysis of infants who underwent MII-pH between October 2009 and July 2018 and received gavage feedings. Infants were divided into two groups: bolus (<30 min) or prolonged (≥60 min). Symptoms, number of reflux events and percent time pH < 4 was compared. RESULT: Fifty-eight infants underwent evaluation. Thirty-one (54%) received bolus gavage feedings and 27 (46%) received prolonged feedings. Groups differed in postmenstrual age. Total reflux episodes were significantly lower with prolonged feeding (median 19 vs. 28 episodes, p = 0.015), with no difference in acid exposure time. There was no significant difference in GER symptoms between the two groups. CONCLUSION: Prolongation of gavage feedings was associated with decreased total numbers of GER events without reduction in GER symptoms.

Assessment of genetically modified soybean MON 87708 × MON 89788 × A5547-127, for food and feed uses, under Regulation (EC) No 1829/2003 (application EFSA-GMO-NL-2016-135).

Soybean MON 87708 × MON 89788 × A5547-127 (three-event stack soybean) was produced by conventional crossing to combine three single events: MON 87708, MON 89788 and A5547-127. The GMO Panel previously assessed the three single events and did not identify safety concerns. No new data on the single events, leading to modification of the original conclusions on their safety have been identified. The molecular characterisation, comparative analysis (agronomic, phenotypic and compositional characteristics) and the outcome of the toxicological, allergenicity and nutritional assessment indicate that the combination of the single soybean events and of the newly expressed proteins in the three-event stack soybean does not give rise to food and feed safety and nutritional concerns. The GMO Panel concludes that the three-event stack soybean, as described in this application, is as safe as and nutritionally equivalent to its conventional counterpart and the non-GM reference varieties tested. The nutritional impact of food/feed derived from the three-event stack soybean is expected to be the same as that of food/feed derived from the conventional counterpart and non-GM reference varieties. In the case of accidental release of viable seeds of the three-event stack soybean into the environment, this would not raise environmental safety concerns. The post-market environmental monitoring plan and reporting intervals are in line with the intended uses of the three-event stack soybean. Post-market monitoring of food/feed is not considered necessary. The GMO Panel concludes that the three-event stack soybean is as safe as its conventional counterpart and the tested non-GM reference varieties with respect to potential effects on human and animal health and the environment.

The impact of cobedding on sleep patterns in preterm twins.

Interest in cobedding multiple-gestation infants has grown as focus has increased on the developmental approach to the care of the neonate. Little data, however, exist on the infants' response to cobedding. It is important to evaluate the safety, efficacy, and physiologic impact of this practice. Cobedding was offered to parents of twin infants < 37 weeks gestation, without arterial lines or ventilator requirements, by the health care team according to standard practice in our nursery. After parental informed consent, infants were placed on an event-recording cardiorespiratory monitor for 12 hours before cobedding and for the first 12 hours of cobedding. Recordings were evaluated by an investigator blinded to the bedding status of the infant. Apnea (a pause of respiration > 10 seconds, central apnea), bradycardia (a decline in heart rate to < 80 beats per minute), periodic breathing (a respiratory pattern in which there are > or = 3 pauses in respiration of > or = 3 seconds with < 20 seconds of breathing between pauses), adverse events (changes in medication, changes in oxygen requirements, temperature instability, the need for sepsis evaluation, or death) were evaluated. Other physiologic parameters were obtained through the use of standard bedside monitoring. Eleven sets of preterm infants, n = 22, with a mean gestation of 31.8+/-2.9 weeks and a mean birth weight of 1,698.7+/-552.0 grams were studied. Infants were evaluated at a corrected gestational age of 33.5+/-1.9 weeks and a mean weight of 1,713.2+/-484.0 grams. The number of events of central apnea before cobedding (57) was greater than those recorded during cobedding (18), p<0.05. There was no difference found in any of the other parameters compared. The numbers of events recorded before and during cobedding were compared by Student's t-test and significance was determined by p < 0.05. No adverse events (AE) were noted, and all infants remained cobedded throughout the study. This preliminary study suggests that cobedding of healthy preterm twins showed no increase in adverse events. Of the physiologic parameters studied, only the occurrence of central apnea changed with cobedding. This decrease in central apnea may reflect a change in sleep pattern due to more frequent arousal by the twin. Alternatively, a more regular breathing pattern may reflect a positive physiological response to contact between twins.