Gastroesophageal reflux incidence and respiratory dysfunction during sleep in infants: treatment with cisapride

We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4-26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24-h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern ("respiratory dysfunction") (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13-16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p less than 0.001). The treatment-related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age-matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p less than 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).     

Milk-thickening agents as a treatment for gastroesophageal reflux

Milk thickening agents are believed to reduce episodes of gastroesophageal reflux, but their use has not been evaluated thoroughly. We studied the effect of these agents in 30 bottle-fed babies, 6-8 weeks old, with clinical gastroesophageal reflux pathology. Continuous 24-hour esophageal pH monitoring revealed gastroesophageal reflux pathology for all parameters studied: reflux index (18.4%), duration of the longest reflux episode (23.3 min), number of reflux episodes in 24 h (34.5), number of reflux episodes greater than 5 min (6.8). All investigations were performed in prone-anti-Trendelenburg position. The infants were treated with milk thickening agents (1 g to 115 ml, as recommended by Carre). Most (n = 25) showed clinical improvement of their symptoms. A second pH monitoring was performed under treatment conditions after 7-14 days, and showed in 24 infants a decrease of the number of reflux episodes (15.1 in 24 h) (p less than 0.001), but a comparable reflux index (17.8%) (NS) and number of long lasting (greater than 5 min) reflux episodes (7.8) (NS). The duration of the longest reflux episode, however, increased significantly (56.6 min) (p less than 0.001). In six infants all parameters were within normal ranges at follow-up. Milk thickening agents seem clinically effective as a treatment for gastroesophageal reflux in individual cases, but can lead to occult gastroesophageal reflux episodes of long duration, possibly increasing the risk for esophagitis or respiratory dysfunction.     

Cisapride in the control of symptoms in infants with gastroesophageal reflux: A randomized, double-blind, placebo-controlled trial

OBJECTIVE: To evaluate the efficacy of cisapride in the treatment of uncomplicated gastroesophageal reflux in children younger than 36 months of age. STUDY DESIGN: A total of 95 patients satisfied the entry criteria and were randomly assigned to double-blind treatment with either cisapride (n = 50), 0.2 mg/kg 4 times daily, or placebo (n = 45) for 2 weeks. At the end of the 2-week treatment period, symptom diary and parental evaluation with repeat 24-hour pH study were performed. RESULTS: Sixty-eight patients completed the trial (38 in the cisapride group and 30 in the placebo group). There were no significant differences in the symptoms of crying, vomiting, or gagging; the overall symptom intensity score; or parental global evaluations. There was a significant difference (P <.03) in the percent time pH <4, the number of reflux episodes lasting more than 5 minutes, and the duration of the longest episode. No significant difference was demonstrated for the number of episodes with pH <4 or the reflux score. CONCLUSIONS: Cisapride was no better than placebo for relief of symptoms in children with uncomplicated gastroesophageal reflux. A beneficial effect was demonstrated in the cisapride group in relation to the measured parameters for esophageal acid exposure time.     

24 h食管pH监测在婴儿难治性肺炎中的临床应用研究

目的探讨24h食管pH监测在婴儿难治性肺炎中的临床应用及其意义。方法对57例难治性肺炎患儿进行24h食管pH监测,监测指标包括食管pH〈4.0的次数、反流时间≥5min的次数、最长反流时间、卧位pH值〈4的时间占总监测时间的百分比和Biox-Ochoa评分。结果57例中存在胃食管反流（GER）28例（占49.1%）;有呕吐与无呕吐症状患儿各项反流指标比较差异有统计学意义;伴有胃食管反流患儿经促动力剂治疗者,肺部罗音消失时间和咳嗽持续时间均较未用促动力剂治疗者短,差异有统计学意义（P〈0.05）。结论难治性肺炎患儿经正规抗炎治疗效果不佳者,应考虑是否合并胃食管反流,进行24h食管pH监测,以确定病因并指导治疗。     

Effect of cisapride on esophageal pH monitoring in children with reflux-associated bronchopulmonary disease

Clinical evaluation and prolonged esophageal pH monitoring were performed before and during treatment with cisapride (0.3 mg/kg t.i.d.) for 1 month in 19 children with reflux-associated bronchopulmonary disease. Results (mean +/- SEM) show that cisapride significantly decreases the frequency of long duration (greater than 5 min) reflux episodes (from 9.7 +/- 0.7 to 5.7 +/- 1.2), the percentage of total time pH was less than 4 (from 15.9 +/- 2.5 to 7.7 +/- 1.1%), the percentage of time pH was less than 4 at night (from 18.0 +/- 3.9 to 4.9 +/- 1.5%), the duration of the longest reflux episodes (from 44.5 +/- 6.4 to 19.7 +/- 2.7 min), as well as the duration of reflux at night (from 100.1 +/- 28.0 to 28.2 +/- 10.1 min). The frequency of reflux episodes, however, remains unaffected by cisapride. Cough fits at night disappeared completely in 12 out of 13 children. We conclude that cisapride given for 1 month significantly decreased gastroesophageal reflux as well as cough episodes at night.     

Gastro-oesophageal reflux in infants

Forty bottle-fed babies, 4–12 weeks old, with clinical gastro-oesophageal reflux were studied. Continuous 24 h oesophageal pH monitoring in a prone position demonstrated a gastro-oesophageal reflux with all of the following parameters: reflux index, duration of the longest reflux episode, number of reflux episodes in 24 h, number of reflux episodes >5 min in 24 h. Positional therapy (prone-antitrendelenburg position), applied to all infants, resulted in a normalization of these parameters in ten of them. The remaining 30 infants were treated with milk-thickening agents, as recommended by Carre. Nearly all (N=25) showed an important clinical improvement. A third pH monitoring was performed after 10–14 days of treatment. In six infants the results were completely within normal ranges. In 24 infants a decrease in the number of reflux episodes was demonstrated, with a comparable reflux index and number of long lasting reflux episodes. The duration of the longest reflux episode however increased significantly (P<0.001). Drugs (domperidone, Gaviscon) added to the milk-thickening agents in these 24 children, led to normalization of pH tracings. Clinical symptoms were less severe or disappeared in all infants but one. We conclude that if positional therapy (prone-antitrendelenburg) does not correct gastro-oesophageal reflux in infants, pharmacological treatment should be applied. Milk-thickening agents alone can be effective in individual cases but should be prescribed with care as they can lead to more occult gastro-oesophageal reflux with episodes of longer duration, increasing the risk of oesophagitis or respiratory distress.Abbreviation GOR gastro-oesophageal reflux     

动态24小时食管pH值监测小儿胃食管返流

为了解２４小时食管ｐＨ值监测在小儿胃食管返流（ＧＥＲ）诊治中的作用，研究小儿病理性ＧＥＲ的特点及其诊断标准，对５０例经钡餐造影诊为ＧＥＲ的患儿进行动态２４小时食管内ｐＨ值监测，３０例健康小儿为对照组，复查１３例病理性ＧＥＲ患儿治疗后（９例为手术治疗）的食管ｐＨ值。结果表明，ＧＥＲ组各项返流指标显著高于对照组。对照组中１例为病理性ＧＥＲ，ＧＥＲ组３１例为病理性，另１９例则为生理性。１３例食管裂孔疝（ＨＨ）患儿均有明显的病理性返流，其各项返流指标除ｐＨ值＜４次数外均显著高于单纯病理性ＧＥＲ；ＨＨ组卧位时返流≥５分钟次数、最长返流时间、总ｐＨ值＜４的时间占总观察时间的百分比和平均返流周期均显著大于立位时；单纯病理性ＧＥＲ组卧位时返流≥５分钟次数、最长返流时间和平均返流周期显著大于立位时，而返流次数则小于立位时。提示小儿病理性ＧＥＲ以卧位时明显，伴有食管裂孔疝者返流更为严重。动态２４小时食管内ｐＨ值监测可用于小儿ＧＥＲ的诊断、分析和疗效评定。     

Continuous 24-hour esophageal pH monitoring in 285 asymptomatic infants 0-15 months old

A continuous 24-h esophageal pH monitoring was performed in 283 asymptomatic infants between 5 days and 15 months old. Several parameters (reflux index, duration of the longest reflux episode, number of reflux episodes in 24 h, number of reflux episodes greater than 5 min in 24 h) were studied in different groups of infants according to their age: 5-15 days old, 24-37 days old, 3.5-4.5 months old, 5.5-6.5 months old, 7.5-8.5 months old, 14-16 months old. For all parameters we obtained statistically significant different results in infants younger and older than 4 months. The 24-h esophageal pH monitoring is an investigation technique in physiological circumstances in order to establish normal ranges for gastroesophageal reflux in asymptomatic infants.     

Seventeen-hour continuous esophageal pH monitoring in the newborn: evaluation of the influence of position in asymptomatic and symptomatic babies

Esophageal pH monitoring has been performed in 60 asymptomatic neonates between 1 and 10 days old. Several parameters (periods with a pH less than 4, number of reflux episodes, number of reflux episodes lasting more than 5 min, average duration of the longest reflux episode, average pH) were studied in different positions (in prone and supine position, in right and left side lying position). For all parameters, except for the average pH, we obtained significantly more favorable results in prone position. In 22 vomiting neonates, significantly favorable results were obtained only by application of positional therapy: in prone position with head elevated (anti-Trendelenburg). There was no significant difference between the symptomatic group (with radiologically proven reflux pathology) in prone and anti-Trendelenburg position, and the control group in prone horizontal position. The 17-h continuous pH monitoring in the newborn is a nonaggressive investigation technique in physiological circumstances, which adequately completes and/or replaces the traditional examinations on gastroesophageal reflux. This method enables an evaluation of the favorable effect of simple therapeutic means (positional changes). Medication, and thickening and staggering of feeding (a time-consuming and tiring burden for the parents), can be avoided with this technique.     

Gastroesophageal reflux with drifting onset in infants: a phenomenon unique to sleep.

We have characterized the gastroesophageal reflux (GER) episodes which occurred during sleep in 28 infants with pathologic gastroesophageal reflux and 10 symptomatic age-matched controls without gastroesophageal reflux. We describe three kinds of episodes during the sleeping period-awake episodes which occur completely during electroencephalogram (EEG)-defined wakefulness associated with clinical evidence of the waking state (62 episodes), episodes occurring during EEG-defined sleep which have a rapid drop in pH at their onset (119 episodes), and episodes occurring during EEG-defined sleep in which the esophageal pH drifts down slowly over a period up to 30 min (113 episodes). Only 9 of the 10 control subjects experienced any reflux episodes during monitoring. The total number of episodes of reflux in controls (34) was less than the total number in reflux subjects (260). Controls did, however, experience all three types of reflux episode. Awake episodes all had a rapid drop in pH at their onset and were characterized by a short acid clearance time (2.0 +/- 0.3 min in reflux patients and 1.0 +/- 0.2 min in controls). The sleep episodes with rapid onset had longer mean acid clearance time than the awake episodes, significantly so in GER subjects (20.1 +/- 6.8 min in reflux subjects and 2.6 + 1.3 min in controls). Body movement was noted at the onset of 93.4% of rapid-onset sleep episodes in reflux subjects and 88.9% in controls. Body movement was also common at the termination of rapid-onset sleep episodes (77.8% of rapid-onset episodes in reflux subjects and 80.0% in controls).(ABSTRACT TRUNCATED AT 250 WORDS)     

PH monitoring in the distal and proximal esophagus in symptomatic infants

BACKGROUND: Standard distal esophageal pH monitoring data are sometimes within normal ranges in children with clinically suspected gastroesophageal reflux disease. Therefore, the authors hypothesized that the amount of acid reflux reaching the proximal esophagus may be greater in some subgroups of patients than in healthy controls or in other subgroups of patients. METHODS: The parameters of 24-hour pH monitoring in the proximal part of the esophagus were analyzed in 120 symptomatic infants in who the reflux parameters in the lower esophagus were clearly within normal ranges (reflux index < 5.0%). The infants were classified into four patient groups: excessive regurgitation (n = 41): inconsolable crying (n = 31), apparent life-threatening event (ALTE) (n = 18), and chronic respiratory disorders (n = 30). The control group consisted also of 120 infants. The following parameters were calculated: reflux index, the number of reflux episodes, the number of reflux episodes lasting longer than 5 minutes, the duration of the longest reflux episode, and the acid clearance time (ACT, duration of reflux episodes divided by number of reflux episodes). RESULTS: The patients with chronic respiratory disorders were significantly older than the patients in the other groups and the controls. In the distal esophagus, there was no statistically significant difference between the reflux parameters. As could be expected, every parameter was statistically (paired t test, Wilcoxon signed-rank test) significantly smaller in the proximal than in the distal esophagus, except for the ACT in infants who presented with inconsolable crying. In the proximal esophagus, there was no statistically significant difference between the different patient subgroups or controls, except for the number of reflux episodes in the group with chronic respiratory disorders and the group with inconsolable crying, applying one-way analysis of variance. As determined by applying the Mann-Whitney test, the number of reflux episodes in the upper esophagus was significantly higher in the group with chronic respiratory disorders than in the other patient groups and controls. Therefore, the authors' data do not support the hypothesis that reflux reaching the proximal esophagus is a frequent cause of ALTE. However, the data may suggest that the number of reflux episodes reaching the proximal esophagus in children with chronic respiratory disorders and with distal pH monitoring data within normal ranges may be increased. Whether this finding reflects reality or a statistical coincidence, or is influenced by the older age of this patient group, needs further evaluation. CONCLUSIONS: In theory, dual simultaneous esophageal pH monitoring in the distal and proximal esophagus may increase the diagnostic accuracy of pH monitoring in infants. Our results do not support a substantial advantage of a systematic application of this new technique, especially not in infants presenting with ALTE, excessive regurgitation, or inconsolable crying. In the subgroup of patients with chronic respiratory disorders, more data are needed before conclusions can be determined and recommendations can be made.     

Efficacy of domperidone in infants and children with gastroesophageal reflux.

This study sought to define the therapeutic efficacy of domperidone in infants and children with gastroesophageal reflux. A double-blind, placebo-controlled trial was performed in seventeen children (ages 5 months to 11.3 years) with moderate to severe gastroesophageal reflux who had not responded to standard nonpharmacological therapy. Subjective and objective measures (weight gain, esophageal pH probe study, radionuclide gastric emptying scan) of gastroesophageal reflux were evaluated. Therapy with domperidone for 4 weeks was effective only in reducing the total number of reflux episodes in the two-hour postprandial period (p less than 0.01); however, it did not result in symptomatic improvement or significant improvement in other measures of gastroesophageal reflux or gastric emptying. After therapy for 8 weeks symptomatic improvement was reported in some patients who had denied improvement after 4 weeks of therapy, suggesting that more than 4 weeks of therapy may be required for some patients to obtain a clinical response. Mild self-limited diarrhea was reported by six patients (four domperidone, two placebo). We conclude that domperidone is tolerated by most infants and children with gastroesophageal reflux; however, 4 weeks of therapy was only minimally effective in producing objective improvement of gastroesophageal reflux and did not result in symptomatic improvement. Further studies of longer duration are needed to resolve the question raised by this study: that domperidone may be beneficial for patients with gastroesophageal reflux when given for more than four weeks.     

Gastroesophageal reflux to the proximal esophagus in infants with bronchopulmonary dysplasia

Recurrent aspiration after gastroesophageal reflux (GER) may contribute to the severity of chronic lung disease. If so, it should be possible to document acid reflux to the proximal esophagus. Using an esophageal pH probe placed at the level of the first or second thoracic vertebra, we evaluated GER in 14 infants with bronchopulmonary dysplasia (BPD) and 13 infants without BPD. The infants with BPD had significantly less GER, as measured by the percentage of time the pH was less than 4 (3.26% +/- 7.05% vs 12.88% +/- 15.27% [mean +/- SD]), number of GER episodes per hour (0.46 +/- 0.66 vs 1.35 +/- 0.83), number of GER episodes lasting longer than 5 minutes per hour (0.10 +/- 0.23 vs 0.31 +/- 0.29), and longest GER episode (6.76 +/- 10.29 vs 26.66 +/- 38.30 minutes). Gastroesophageal reflux may be unimportant in infants with BPD, or even occasional episodes of GER may aggravate existing lung disease.     

24h食管pH监测在婴儿喘息性疾病中的应用

目的探讨24 h食管pH监测在婴儿喘息性疾病中的应用。方法对74例喘息性疾病婴儿进行24 h食管pH监测,监测指标包括食管pH<4.00的次数、反流时间≥5 min的次数、最长反流时间、卧位pH<4.00的时间占总监测时间的百分比以及Biox-Ochoa评分;对所有喘息患儿按照病情分为持续性喘息组和一般喘息组,比较2组24 h食管pH监测情况;将其中有病理性胃食管反流(GER)的40例患儿随机分为治疗组和对照组。对照组给予常规抗炎、平喘治疗,治疗组在抗炎、平喘治疗基础上加用抗GER治疗。比较2组患儿住院时间和肺部啰音消失时间?峁?4例喘息性疾病患儿病理性GER发生率为54.0%。其中持续性喘息组病理性GER发生率(69.4%),显著高于一般喘息组(39.5%);持续性喘息组各项反流指标均高于一般喘息组(Pa<0.01)。治疗组患儿住院时间、肺部啰音消失时间均较对照组明显缩短,差异均有统计学意义(Pa<0.01)。所有患儿在24 h食管pH监测中未出现严重不良反应,无终止监测的发生。结论喘息性疾病患儿病理性GER发生率高,持续性喘息患儿发生率更高。伴有病理性GER的喘息患儿经抗GER治疗后效果明显。24 h食...     

Metoclopramide in gastroesophageal reflux of infancy

This study examined the effect of metoclopramide on lower esophageal sphincter (LES) pressure, and frequency and duration of reflux episodes in 28 children (mean age (+/- SD) 9 +/- 11 months) referred for evaluation of gastroesophageal reflux (GER). Esophageal manometry was performed before and after one intravenous dose of metoclopramide (0.125 mg/kg), and esophageal pH was monitored over a 24-hour baseline period, followed by oral metoclopramide therapy (0.125 mg/kg four times a day, for 24 hours.) During pH monitoring, patients received diet for age and were kept in the prone position with the head elevated 45 degrees while sleeping. Eight patients entered a 6-month double-blind, placebo-controlled trial of metoclopramide. Metoclopramide significantly (P = 0.04) increased end-expiratory LES pressure, from 14.9 +/- 7.5 mm Hg to 18.6 +/- 6.8 mm Hg. However, there was a significant (P less than 0.05) increase in the number of reflux episodes/24 hours, and no significant change in percentage of time pH was less than 4, number of episodes lasting greater than 5 minutes, or the longest episode of reflux between the 24-hour baseline and M periods. LES pressure did not correlate well with any of these measurements (r = 0.2). In the controlled trial, the three patients receiving metoclopramide, but none of those receiving placebo, were withdrawn by their parents because of exacerbation of GER symptoms and marked irritability (P = 0.01). In the placebo group, symptoms improved in four infants, but did not change in one. The use of metoclopramide in the treatment of GER of infancy needs to be reconsidered.     

Double-blind controlled study on the efficacy of sodium alginate (Gaviscon) in reducing gastroesophageal reflux assessed by 24 h continuous pH monitoring in infants and children

We studied the effects of an alginate compound (Gaviscon) on the frequency and the duration of gastroesophageal reflux (GOR) episodes in children. Twenty infants and children with characteristic symptoms of GOR were divided at random into two groups which were given either Gaviscon (ten patients, mean age: 21 months) or a placebo (ten patients, mean age: 35 months). A continuous pH probe monitoring of the lower oesophageal third was performed in all the patients before and after 8 days of treatment. Before the trial, sensitive pH monitoring variables of acid reflux (Euler-Byrne index, percentage of total reflux time per 24 h, mean duration and percentage of reflux time during sleep, total number of reflux episodes per 24 h and number of reflux episodes per 2 h post-cibal periods) were abnormal in all the patients tested. The oesophagram revealed a GOR in 13 of the 20 patients; none of the children who underwent an endoscopy had evidence of oesophagitis. Episodes of regurgitation reported by the parents decreased during Gaviscon therapy while no clinical improvement was noticed in the placebo group. No adverse effects were observed. After 8 days of treatment with Gaviscon, results of all the pH monitoring variables were significantly (P<0.05) reduced between -35% and -61% of the initial values recorded. In the placebo treated group, the mean values remained little changes (-9.5 to + 8.2% of initial values). These data suggest that Gaviscon may prove useful in the medical management of GOR in infants and children.     

Randomized, prospective double-blind trial of metoclopramide and placebo for gastroesophageal reflux in infants

The effect of metoclopramide on gastroesophageal reflux was studied in 30 infants less than 1 year of age. Gastroesophageal reflux was documented in all infants by extended pH monitoring before enrollment in the study. Patients were randomly assigned to receive metoclopramide 0.1 mg/kg or placebo four times a day, 1/2 hour before feeding for 1 week, followed by the alternate regimen for 1 week. The infants were reevaluated with extended pH monitoring and scintigraphy after 4 to 7 days of each treatment. A symptom score was derived by determining the average number of occurrences of all symptoms recorded daily by parents on a symptom checklist during pretreatment, placebo, and metoclopramide treatment periods. There was a difference between pretreatment evaluation and placebo periods with respect to daily symptom scores (p less than 0.005), reflecting a significant placebo response. However, no difference in scintigraphic study was found between placebo and metoclopramide periods. A significant difference between placebo and metoclopramide periods was noted in the percentage of time esophageal pH was less than 4.0 (p less than 0.001). However, although metoclopramide decreased the proportion of time esophageal pH was less than 4.0, pH remained less than 4.0 for more than 5% of the time in most patients. Substratification of the total group into infants younger and older than 3 months revealed that older infants had greater average daily weight gain during the metoclopramide treatment period (34.3 gm/day) than in the placebo treatment period (6.6 gm/day, p = 0.05). We conclude that metoclopramide in the dosage 0.1 mg/kg four times daily reduces reflux in infants and may be useful for infants with poor weight gain and other serious complications of gastroesophageal reflux.     

Esophageal reflux in symptomatic and asymptomatic infants: postprandial and circadian variations

Twenty-two full-term infants, nine asymptomatic and 13 symptomatic for chronic digestive problems, had long-term (mean = 21 h) esophageal pH monitoring. All children were observed in strictly standardized conditions including meals and body position. Symptomatic infants presented significantly more esophageal refluxes, spent a greater percentage of time with a pH below 4, had a longer reflux duration (longer clearing time) and presented more refluxes lasting more than 5 min. We performed a determination of the circadian variations of parameters associated with esophageal reflux. Asymptomatic and symptomatic infants presented significant circadian variations of the percentage of time below pH 4 and of the longest duration of reflux. However, symptomatic infants had significantly higher mean values and increased amplitudes of circadian rhythms. Moderate phase lag existed for certain variables between symptomatic and asymptomatic infants. These findings can be helpful when interpreting the results of long-term esophageal pH monitoring.     

小儿哮喘与胃食管返流的研究

为探讨小儿哮喘与胃食管返流（ＧＥＲ）的关系，采用便携式ｐＨ自动记录仪对４１例反复发作的哮喘患儿进行了２４小时食管ｐＨ值监测，以２０例健康儿作为对照组。结果：哮喘组胃食管返流发生率为５３．７％（２２／４１），显著高于对照组（０／２０）；哮喘组Ｂｏｉｘ－Ｏｃｈｏａ综合评分、酸性返流指数、返流≥５分钟次数均显著大于对照组，而ｐＨ值＜４的次数、最长返流持续时间则与对照组差异无显著意义（Ｐ＞０．０５）。提示：反复发作的哮喘患儿胃食管返流发生率较高，哮喘与胃食管返流之间有密切的关系。     

非营养性吸吮对早产儿胃排空及胃食管反流的影响

目的评价非营养性吸吮(NNS)对早产儿胃排空及胃食管反流的影响.方法将38例需经鼻胃管喂养(INGF)的健康早产适于胎龄儿,用同一种配方乳喂养.根据是否辅以非营养性吸吮随机分为非营养性吸吮(NNS)组和单纯鼻胃管喂养(N-NNS)组.记录入液量、奶量、热卡及肠道营养达418.4 kJ/(kg·d)的时间,记录喂养相关情况;测定胃窦纵切面积(ACSA),计算胃半排空时间(T1/250%ΔACSA);同时进行食管24小时pH监测,记录以下指标24小时内总反流次数;反流指数(RI);反流持续时间>5分次数;pH<4总时间;最长酸反流时间.结果 NNS组胃半排空时间快于对照组[分别为(58.33±22.94)分,(73.75±17.76)分],差异有显著意义(P<0.05).38例早产儿中出现GER者32例,占84.2%;NNS组反流次数明显少于对照组[分别为9(2～31)次,(5～31)次,P<0.05];pH<4的总时间和反流指数与对照组比较,有下降趋势,但差异无显著意义(P>0.05).NNS组胃残留发生率(16.7%)低于对照组(50%),差异有显著意义(P<0.05);肠道营养达418.4kJ/(kg·d)的时间比对照组明显缩短[分别为(12.36±4.29)天,(15.50±4.58)天,P<0.05].结论鼻胃管喂养期间给予NNS是一种简单而安全的喂养方式,可促进胃排空,减少胃食管反流次数,对胃肠动力发育有促进作用,有助于早产儿生后肠道营养的建立.