Gastro-esophageal reflux in symptomatic preterm infants: lack of efficacy of a new preterm thickened formula

Background and Aims: Gastro-oesophageal reflux (GER) is a common condition in preterm infants. The management usually begins with nonpharmacologic approaches (body positioning/milk thickening). However, the thickened formulas role is still debated and at present, commerciallyavailable thickened formula are not adequate to satisfy preterm nutritional needs. The aim of this study was to evaluate the efficacy of an amylopectin-thickened formula on GER by combined pH-impedance monitoring (pH-MII). The tested formula is specifically thought to satisfy the nutritional needs of preterm infants. Methods: Twenty-five symptomatic preterm infants (GA <33 weeks) after they reached full enteral feeding (150 ml/kg/day) underwent a 24-hour pH-MII. During the analysis, eight meals were administered: 4 with preterm formula (PF) and 4 with thickened preterm formula (TPF). Acid and non-acid GER indexes detected after PF and TPF meals were compared by Wilcoxon Signed Ranks Test. Results: All the infant had well tolerated the study period. After TPF meals a lower number of acid GER [median 22 (range, 1–67) vs 28 (range, 0–85) after PF meals, p = 0.036] and a lower number of total GER [median 45 (range, 2–84) vs 49 (range, 10–117), p = 0.054] were observed. No difference was detected between TPF and PF concerning non-acid GER indexes. Conclusions: Results of present study showed that acid GER might be reduced in preterm infants by a thickened formula. However, it has no effect either on non-acid GER, nor on total acid exposition. These results need to be confirmed by further data from a larger population.