P0927 TRANSPYLORIC FEEDING IN PREMATURE INFANTS WITH SUSPECTED GASTROESOPHAGEAL REFLUX ASSOCIATED APNEA

Abstract

Introduction: Though gastroesophageal reflux (GER) is often implicated in neonatal apnea, both conditions commonly coexist in premature infants. We report use of transpyloric feeding in suspected GER associated apnea. Methods: Charts of premature infants on transpyloric feed were reviewed. Newborns with documented apnea were included in this study. Continuous transpyloric feeding was in persistant apnea after exclusion of etiologies or obvious correlation between GER and apnea. Descriptive statistics and t test were used to analyze the data. Results: Thirty-two newborns were put on transpyloric feeding between July 2000 and December 2003. Twelve of them had documented apnea. The mean gestational age and birth weight of these neonates were 27.44 + 3.16 weeks (range 26 to 36.3 weeks) and 1035.16 + 407.33 grams (range 680 to 2190 grams) respectively. Transpyloric feeding was started at a mean chronological age of 32.25 + 9.34 days (range 20 to 51) and continued for an average of 19.83 + 14.86 days (range 4 to 48). Acid suppressor and metoclopramide was used in 9 (ranitidine, 2 with additional omeprazole in 2) and 10 subjects respectively without benefit. Though transpyloric feeds significantly reduced (p< .05) the average rate of apnea per day in the whole group, two infants did not show any reduction of number of apneas. Among the remaining 10, the average number of daily apneas dropped from 2.9 + 2.02 (range 1 to 8) to 0.7 + 0.67, (range 0 to 2, p < .01) on transpyloric feeds. One subject underwent antireflux surgery and another was transferred on transpyloric feeds. Rest did well clinically after discontinuation of transpyloric feeds. No transpyloric tube related complication was documented. Conclusion: The association between GER and apnea is difficult to establish even with sophisticated tests. In a properly selected population, transpyloric feeds can be used for diagnosis and management of gastroesophageal reflux associated apnea.