Background and Aims: Apnoea of prematurity (AOP) is a perplexing disorder of respiratory control which is very common in preterm infants and requires therapeutic intervention to avoid potential morbidity. The existence of a relationship between gastroesophageal reflux (GER) and AOP in preterm infants is still controversial. This hypothesis is suggested by the clinical observation that both GER and apnoeas frequently occur during post-prandial periods. In clinical practice, many preterm infants receive pharmacological treatment for GER, with expectation that treatment would reduce also the frequency and severity of apnoea episodes. However, recent evidence suggests an association between the use of different drugs which are commonly used in preterm infants to treat GER and serious adverse effects i.e. ranitidine and necrotizing enterocolitis. For this reason, first-line treatment for GER in preterm infants should be conservative. Milk thickening and body positioning are the conservative options more often used and studied in preterm infants. Milk thickening has proven to be effective in infants with GER; however, the main limitation of this treatment in preterm newborn is that, at present, commercially-available thickened formula are not adequate to satisfy preterm newborn’s high nutritional needs. The aim of the present study is to evaluate the effect of an amylopectinthickened formula specifically designed for preterm infants on AOP and on GER-induced AOP. Materials and Methods: Eighteen preterm infants (gestational age <33 weeks) with recurrent apnoeas underwent a six-hour simultaneous and synchronized recording of polysomnography and pH-impedance monitoring (pH-MII). Each oral/nasal flow cessation lasting at least 5 seconds was considered as apnoea. Apnoeas detected within 30 seconds after the onset of GER were defined as GER-induced. Each patient received 2 meals, one of preterm formula (PF) and the other of a thickened formula specifically designed to satisfy preterm infants’ nutritional needs (TPF). AOP and GER-induced AOP detected after PF and TPF meals were recorded and compared by Wilcoxon Signed Ranks Test. A p value ≤0.05 was considered statistically significant. Results: One-hundred-twenty-seven apnoeas were recorded after TPF (mean 5/patient, range 0–21), whereas 118 apnoeas were recorded after PF (mean 4.5, range 0–27). A lower number of GER-induced AOP was detected after TPF meals (3 vs 7 after PF meals). No significant differences between TPF and PF in the number of AOP and GER-induced AOP were found. Conclusions: Preliminary results of the present study show that a thickened formula specifically designed for preterm infants is ineffective in reducing total number of AOP and also GER-induced AOP. Further data from a larger population are needed to confirm these results.
Efficacy on apnoeas induced by gastroesophageal reflux of a thickened formula designed for preterm infants
ACETI, ARIANNA;CORVAGLIA, LUIGI TOMMASO
2011
Abstract
Background and Aims: Apnoea of prematurity (AOP) is a perplexing disorder of respiratory control which is very common in preterm infants and requires therapeutic intervention to avoid potential morbidity. The existence of a relationship between gastroesophageal reflux (GER) and AOP in preterm infants is still controversial. This hypothesis is suggested by the clinical observation that both GER and apnoeas frequently occur during post-prandial periods. In clinical practice, many preterm infants receive pharmacological treatment for GER, with expectation that treatment would reduce also the frequency and severity of apnoea episodes. However, recent evidence suggests an association between the use of different drugs which are commonly used in preterm infants to treat GER and serious adverse effects i.e. ranitidine and necrotizing enterocolitis. For this reason, first-line treatment for GER in preterm infants should be conservative. Milk thickening and body positioning are the conservative options more often used and studied in preterm infants. Milk thickening has proven to be effective in infants with GER; however, the main limitation of this treatment in preterm newborn is that, at present, commercially-available thickened formula are not adequate to satisfy preterm newborn’s high nutritional needs. The aim of the present study is to evaluate the effect of an amylopectinthickened formula specifically designed for preterm infants on AOP and on GER-induced AOP. Materials and Methods: Eighteen preterm infants (gestational age <33 weeks) with recurrent apnoeas underwent a six-hour simultaneous and synchronized recording of polysomnography and pH-impedance monitoring (pH-MII). Each oral/nasal flow cessation lasting at least 5 seconds was considered as apnoea. Apnoeas detected within 30 seconds after the onset of GER were defined as GER-induced. Each patient received 2 meals, one of preterm formula (PF) and the other of a thickened formula specifically designed to satisfy preterm infants’ nutritional needs (TPF). AOP and GER-induced AOP detected after PF and TPF meals were recorded and compared by Wilcoxon Signed Ranks Test. A p value ≤0.05 was considered statistically significant. Results: One-hundred-twenty-seven apnoeas were recorded after TPF (mean 5/patient, range 0–21), whereas 118 apnoeas were recorded after PF (mean 4.5, range 0–27). A lower number of GER-induced AOP was detected after TPF meals (3 vs 7 after PF meals). No significant differences between TPF and PF in the number of AOP and GER-induced AOP were found. Conclusions: Preliminary results of the present study show that a thickened formula specifically designed for preterm infants is ineffective in reducing total number of AOP and also GER-induced AOP. Further data from a larger population are needed to confirm these results.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
