BIRTH ASPHYXIA ALTERS GASTRIC EMPTYING TIME AND GASTRIC ELECTRICAL ACTIVITY IN TERM AND PRETERM NEONATES

Abstract

16 Neonates with birth asphyxia exhibit a high prevalence of feeding difficulties which are thought to be multifactorial. Since motility of the gut is mainly regulated by central and intrinsic nervous systems and asphyxia might damage neuroregulatory control of intestinal motility through hypoxia and/or hypoperfusion (Pediatrics 1992;90:669) it was of clinical interest to record in asphyxiated neonates gastric emptying time (GET) and gastric electrical activity (GEA) which are crucial factors in allowing successful enteral nutrition in neonates. We have studied 5 term and 6 preterm asphyxiated neonates (gestational age: 29-34 weeks) who fulfilled at least two of the following criteria: 1) an Apgar score 0-3 at 1 min and 0-5 at 5 min; 2) need for ventilatory support for recurrent uncontrollable seizures; 3) blood pH < 7.01 and base deficit > 13 mm/L. These infants underwent simultaneous recordings of GEA, through cutaneous electrogastrography (EGG) (normal electrical rhythm: 3 cpm), and of GET through real time two dimensional ultrasound (US) of the gastric antrum (T/2, i.e. the time in minutes taken for antral cross sectional area to decrease by half). Data were compared with controls (6 preterm and 7 term neonates) similar with respect to gestational age, birth weight and post-natal age. Studies were done within the first three life days and 10-12 days later. Results: both GET and GEA were deranged in the two groups of patients (basal recording; T/2 (minutes); term: 83±20.8, preterm: 81.3±19; controls: 51±5.8, 47.7±6, p<0.01 - EGG [% of 3 cpm rhythm]; term: 42±17.5, preterm: 29.2±13; controls: 59.5±2.6, 52±15, p<0.01). Only preterm asphyxiated neonates showed an improvement of motility variables at the second recording session (T/2; term: 77±21, N.S.; preterm: 66.4±19, p<0.01) - EGG [% of 3 cpm rhythm]; term: 45.4±13, N.S.; preterm: 58.3±13, p<0.01). Conclusions: in preterm and term neonates who have experienced asphyxia abnormalities of gastric mechanical and electrical activities are detected. They may be responsible for feeding intolerances commonly reported in these subjects. Among neonates with birth asphyxia preterm infants exhibit a better recovery of gastric motor function than term infants. Serial measurements of gastric motor and electrical activities can be a sensitive method to define feeding readiness.