Highlighted in the November issue of the Journal of Parenteral and Enteral Nutrition, this is the first study to examine the impact feeding variables have on the characteristics of gastroesophageal reflux (GER) in infants.
GER is a condition in which the stomach contents leak backwards from the stomach into the esophagus. It is a frequent occurrence in infants with feeding problems who are receiving care in the neonatal intensive care unit (NICU). About 48 percent of premature infants are discharged from the NICU on acid-suppressive medications.
The first step of managing GER often includes advice on feeding strategies. Feeding strategies, including the method by which feeds are administered, are often changed for NICU infants because of complications suspected to be linked to GER. However, the impact of feeding methods on the prevalence of GER events is not clear.
“Knowledge about the characteristics of GER events across the feeding cycle in relation to different feeding strategies in premature infants may clarify prevailing myths about neonatal GER and feeding methods,” said Sudarshan R. Jadcherla, MD, FRCPI, DCH, AGAF, director of The Neonatal and Infant Feeding Disorders Program at Nationwide Children’s Hospital and lead author of this study.
To evaluate the impact of feeding variables on the acid and nonacid characteristics of GER events, Dr. Jadcherla led the evaluation of 35 infants with feeding problems who were suspected to have GER. The team tested the effects of feeding methods, feeding volumes, feeding duration, feeding flow rates, postprandial phases, feeding type (human milk or formula) and caloric density on the frequency and acid characteristics of GER events. They found higher GER rates in oral-fed infants as compared to tube-fed groups. Tube-fed infants were not naturally at increased risk for GER because on an indwelling tube. Longer feeding duration and slower milk intake or slower milk flow rates were associated with fewer GER events. The type of milk (breast milk or formula) or its caloric density had no increased effects on GER frequency or characteristics.
“The findings of this study support that modifying feeding duration and feeding flow rate can significantly reduce the frequency and characteristics of GER events,” said Dr. Jadcherla, also professor of Pediatrics at The Ohio State University College of Medicine. “Our findings indicate that higher GER rates in oral-fed infants as compared to the gavage-fed group are contrary to the frequent speculation in current clinical practice.”