Abstract
ObjectiveTo characterize esophageal motility and esophago-gastric junction (EGJ) function during feeding in neonatal intensive care unit (NICU) patients.Patients and MethodsHigh resolution manometry with impedance (HRIM) was used to investigate esophageal motility and EGJ function in patients admitted to the NICU. Twenty-eight preterm born infants with bronchopulmonary dysplasia (BPD), 12 born with isolated congenital diaphragmatic hernia (iCDH), and 10 with esophageal atresia (EA) were included. Thirteen healthy infants were included as controls. Esophageal motility and EGJ function were analyzed using objective esophageal bolus transport parameters.ResultsNormal esophageal peristaltic wave patterns were observed in all investigated infants without EA. Nine of 10 patients with EA presented with abnormal esophageal motor wave patterns. A total of 224 nutritive swallows were analyzed (controls, n = 48; BPD, n = 96; iCDH, n = 60; EA, n = 20). Infants with BPD and iCDH had similar distal contractile strength (DCI) compared to healthy controls, while in patients with EA, DCI was significantly lower (Kruskal-Wallis test, p = 0.001). In most infants, EGJ relaxation after swallowing was unaffected. EGJ barrier function, in terms of EGJ-contractile integral, also appeared well-developed and did not differ significantly among patient groups.ConclusionsWe conclude that esophageal motility studies using pressure-impedance analysis are feasible in young infants. Bolus transport mechanisms following nutritive swallows appeared well-established in all investigated infants with the exception of those with EA. EGJ relaxation was also functional after deglutition and EGJ function as an anti-reflux barrier appeared well-developed in all investigated NICU groups.
Highlights
Infants admitted to the neonatal intensive care unit (NICU) commonly present with feeding problems, such as decreased oral intake and feeding intolerance and may suffer from complex diseases, involving prematurity or congenital malformations
There are only few data relating to objective esophageal bolus transport parameters during nutritive swallows in preterm infants [5] and in preterm infants with feeding problems suffering from bronchopulmonary dysplasia (BPD) [6]
Patients were categorized in four groups: 28 infants with BPD, 12 with isolated congenital diaphragmatic hernia (iCDH), and 10 with esophageal atresia (EA) and their results compared with data from 13 healthy infants
Summary
Infants admitted to the neonatal intensive care unit (NICU) commonly present with feeding problems, such as decreased oral intake and feeding intolerance and may suffer from complex diseases, involving prematurity or congenital malformations. The origin of such feeding problems may be disease-specific or can be secondary to numerous factors, including illness severity, associated medical conditions, or surgical interventions. The physiology of distal esophageal motility in dry swallows was described in healthy, preterm infants two decades ago [2, 3]. There are only few data relating to objective esophageal bolus transport parameters during nutritive swallows in preterm infants [5] and in preterm infants with feeding problems suffering from bronchopulmonary dysplasia (BPD) [6]
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