Symptomatic Preterm Infants Research Articles

Postnatal management of preterm infants with spinal muscular atrophy: experience from German newborn screening

BackgroundThe introduction of newborn screening (NBS) for spinal muscular atrophy (SMA) has increased the early diagnosis of 5q-associated SMA in presymptomatic and symptomatic preterm infants. National and international recommendations for treating preterms and newborns < 38 weeks of gestational age are unavailable. Our retrospective multicentre study aimed to evaluate the postnatal clinical course of preterm infants with 5q-associated SMA diagnosed since the implementation of NBS in Germany in 2021 and to summarize the German experience regarding the decision-making process for available treatment regimens for preterm infants with ≤ 3 survival of motor neuron 2 (SMN2) copies.ResultsTwelve preterm infants with 5q-associated SMA and a mean gestational age of 34.0 weeks (range: 26.1–36.8) and birth weight of 2022 g (range: 645–3370) were reported from 8/20 German SMA NBS follow-up centers using a pseudonymized questionnaire. Confirmatory diagnosis, including SMN2 copy number, was completed on average on postnatal day 13. All patients had a biallelic deletion of exon 7 or exons 7 and 8 of the survival of motor neuron 1 (SMN1) gene, with SMN2 copy numbers of two in 10 patients and three in two patients. The neonatal course was complicated by respiratory distress due to prematurity (n = 2), sepsis (n = 2), and jaundice (n = 2). At birth, 11 preterm infants (91.6%) were presymptomatic. However, the neurological status of one patient deteriorated at five weeks of age (postconceptional age of 41.8 weeks) prior to the start of treatment. Disease-modifying treatments were initiated in all patients at a mean postconceptional age of 38.8 weeks, with the majority receiving onasemnogene abeparvovec (83.3%, including 2 patients with prior risdiplam bridge therapy). Notably, consensus among participating experts from German neuromuscular centers resulted in 83.3% of patients receiving disease-modifying treatment at term.ConclusionsPremature infants with SMA require interdisciplinary care in close collaboration with the neuromuscular center. SMA NBS facilitates early initiation of disease-modifying therapy, ideally during the presymptomatic phase, which significantly influences the prognosis of the newborn.

Symptomatic preterm infants suffer from lung function deficits, regardless of bronchopulmonary dysplasia.

The long-term respiratory consequences for children with bronchopulmonary dysplasia (BPD) are well known. However, there is little emphasis on monitoring preterm infants without BPD. Few studies have explored the lung function status of infants with the symptoms of chronic lung disease of prematurity (CLD). To evaluate functional lung deficits in preterm infants with CLD, and to assess the perinatal determinants of diminished lung function. In our cross-sectional study, 132 preterm infants with symptomatic CLD underwent infant pulmonary function testing (iPFT) at a median post-term age of 0.9 years. The iPFT included bodypletysmography, compliance measurement, tidal breath analysis, and rapid thoracoabdominal compression. The relationships between the respective z scores of the iPFT parameters and perinatal characteristics, postnatal treatment, and BPD status were investigated. Seventy-threepatients (55.3%) were born before the 28th week of gestation, and 92 (69.7%) met the BPD criteria. Functional deficits were detected in 85.8%. The obstructive ventilatory pattern was more prevalent than restrictive (36.3 vs. 12.4%, p < 0.001). Infants with restriction had lower birth weight (BW) and required a longer duration of oxygenotherapy. In a univariate model, the lung function correlated with the duration of invasive mechanical ventilation, gestational week, and BW. In a general linear model, BPD status was not an additional determinant of the iPFT results. IPFT may reveal significant functional deficits in preterm infants with CLD even without BPD. The current symptoms and perinatal factors may be more important determinants of functional deficits than the BPD status itself.

Outcomes in symptomatic preterm infants with postnatal cytomegalovirus infection.

ABSTRACTPremature infants are at risk for developing symptomatic postnatal cytomegalovirus (CMV) disease, including sepsis-like syndrome. We performed a retrospective case–control study including infants born before 32 weeks of gestation and diagnosed with symptomatic postnatal CMV infection during the neonatal period. Neurodevelopmental outcome was evaluated using the Kyoto Scale of Psychological Development 2001 at 18 months of corrected age and at 3 years of age. Twenty-four infants were diagnosed with postnatal CMV infection; of them, 14 had sepsis-like symptoms and 10 had laboratory test abnormalities only. Home oxygen therapy was used significantly higher in the CMV-positive group compared with the control group at hospital discharge (52% vs 21%, P=0.032). The incidence of neurodevelopmental impairment was not significantly different between the two groups at 18 months of corrected age (29% vs 17%, P=0.48) and at 3 years of age (43% vs 29%, P=0.34). Postnatal CMV infection did not have a significant influence on neurodevelopmental outcomes of symptomatic preterm infants, although those in the CMV-positive group appeared worse. Larger studies with long-term follow-up are needed for a better understanding of continued neurodevelopmental outcomes in preterm infants with postnatal CMV infection.

Simultaneous Videofluoroscopy and Endoscopy for Dysphagia Evaluation in Preterm Infants-A Pilot Study.

Introduction: The assessment of dysphagia in preterm infants has been limited to clinical bedside evaluation followed by videofluoroscopic swallow study (VFSS) in selected patients. Recently, fiberoptic endoscopic evaluation of swallowing (FEES) is being described more in literature for preterm infants. However, it is unclear if one test has a better diagnostic utility than the other in this population. Furthermore, it is also unclear if performing FEES and VFSS simultaneously will increase the sensitivity and specificity of detecting dysphagia compared to either test performed independently.Objectives: The primary objective of this study is to evaluate the feasibility of performing VFSS and FEES simultaneously in preterm infants. Our secondary objective is to determine whether simultaneously performed VFSS–FEES improves the diagnostic ability in detecting dysphagia in preterm infants compared to either test done separately.Methods: In this pilot study, we describe the process involved in performing simultaneous VFSS–FEES in five preterm infants (postmenstrual age ≥36 weeks) with dysphagia. A total of 26 linked VFSS–FEES swallows were analyzed, where the same bolus during the same swallow was compared using simultaneous fluoroscopy and endoscopy. The sensitivity and specificity of detecting penetration and aspiration were evaluated in simultaneous VFSS–FEES compared with each test done independently.Results: Our results demonstrated that performing simultaneous VFSS–FEES is feasible in preterm infants with dysphagia. All patients tolerated the procedures well without any complications. Our pilot study in these five symptomatic preterm infants demonstrated a low incidence of aspiration but a high incidence of penetration. Simultaneous VFSS–FEES (26 linked swallows) improved the ability to detect penetration compared to each test done separately.Conclusion: To our knowledge, this study is the first to demonstrate the feasibility of performing VFSS and FEES simultaneously in symptomatic preterm infants with dysphagia resulting in potentially higher diagnostic yield than either procedure done separately.

Burden, Etiology, and Risk Factors of Respiratory Virus Infections Among Symptomatic Preterm Infants in the Tropics: A Retrospective Single-Center Cohort Study.

The burden of respiratory viral infections (RVIs) among preterm infants in the first few years of life, especially those living in the tropics with year-long transmissions of respiratory viruses, remains unknown. We aimed to describe the clinical epidemiology and associated risk factors for RVIs among symptomatic preterm infants ≤32 weeks up to 2 years of life. We performed a data linkage analysis of clinical and hospital laboratory databases for preterm infants born at KK Women's and Children's Hospital, Singapore, from 2005 to 2015. RVI episodes during initial admission and subsequent hospital readmissions were included. Of 1854 infants in the study, 270 (14.5%) infants were diagnosed with at least 1 RVI. A total of 285 (85.3%) episodes were diagnosed postdischarge, with the highest risk for RVIs being from 3 to 5 months of age. The incidence of RVI in this population was 116 per 1000 infant-years and respiratory syncytial virus was the main overall causative pathogen. Infants with RVIs were more likely to be born at ≤27 weeks' gestational age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.3), to have received postnatal steroids (OR, 1.5; 95% CI, 1.0-2.1), and to be diagnosed with bronchopulmonary dysplasia (OR, 1.7; 95% CI, 1.2-2.4). The burden of RVIs is high in preterm infants in the tropics, affecting >1 of 10 infants born at ≤32 weeks' gestation before 2 years of age. Respiratory syncytial virus was the main causative pathogen identified. Risk factors for RVI included extremely low gestational age, receipt of postnatal steroids, and bronchopulmonary dysplasia.

Consider pharmacological treatment to close patent ductus arteriosus in preterm infants when the condition is haematologically significant

The management of patent ductus arteriosus (PDA) in preterm infants may take a conservative, pharmacological and/or surgical approach. Pharmacological treatment to close the ductus may be indicated in symptomatic preterm infants with haematologically significant PDA. Indomethacin and ibuprofen (the only approved agents for PDA in the USA) appear to have similar efficacy in this indication; however, ibuprofen generally has a better tolerability profile. Paracetamol (acetaminophen) is becoming increasingly used, despite a lack of clinical data. Surgery is an option in infants with refractory PDA or contraindications to drug therapy.

Clinical features of urinary tract infection in infants born preterm

Urinary tract infection (UTI) is common among young infants. The diagnosis of UTI requires a better understanding of the clinical and laboratory presentations in this age group. This study describes the clinical and laboratory aspects of UTI in young infants who were born preterm compared with infants who were born full term. All infants aged less than 3 months who had their first episode of UTI (excluding infants with UTI that occurred during neonatal intensive care unit stay) between July 2003 and June 2006 were retrospectively analyzed. A total of 73 infants (32 preterm and 41 term) were included. Clinical and laboratory presentations were compared between the two groups. Overall, 49.3% of patients had fever, 52% had poor feeding, 47.9% had vomiting, and 39.7% had apnea. There were no significant differences in clinical features of UTI between the two groups. Term infants had an elevated C-reactive protein in 45% of cases, leukocytosis in 30.8% and thrombocytosis in 61.5%, while preterm infants had elevated C-reactive protein in 21.9% of cases, leukocytosis in 3.6%, and thrombocytosis in 35.7%, (P = 0.041, P = 0.037, and P = 0.008, respectively). Urinary leukocytes were present in 40% of term and in 26% of preterm infants (P = 0.360). There was no difference in vesicoureteral reflux between the two groups. Clinical features of UTI of early infancy were similar in preterm and term infants. Both groups had similar vesicoureteral reflux. Symptomatic preterm infants with UTI were less likely to have abnormal laboratory findings.

Are Infants with Bronchopulmonary Dysplasia Prone to Gastroesophageal Reflux? A Prospective Observational Study with Esophageal pH-Impedance Monitoring

To perform an observational cohort study with esophageal pH-multichannel intraluminal impedance (pH-MII) monitoring in symptomatic preterm infants with and without bronchopulmonary dysplasia (BPD). We prospectively studied 46 infants born ≤32 weeks gestational age: 12 infants with BPD and 34 infants without BPD. Each patient had symptoms consistent with gastroesophageal reflux and had 24-hour pH-MII, which were compared between BPD and non-BPD by univariate analysis and quantile regression analysis. Demographic and clinical characteristics were similar between infants with and without BPD, except for fluid administration (145 vs 163 mL/kg/d, P = .003), length of stay (92 vs 69 days, P = .019), and time to achieve complete oral feeding (76 vs 51 days, P = .013). The analysis of 1104 hours of pH-MII tracings demonstrated that infants with BPD compared with infants without BPD had increased numbers of pH-only events (median number 21 vs 9) and a higher symptom sensitivity index for pH-only events (9% vs 4.9%); the number and characteristics of acid, weakly acid, nonacid and gas gastroesophageal reflux events, acid exposure, esophageal clearance, and recorded symptoms did not significantly differ between the 2 groups. The increased number of (and sensitivity for) pH-only events among infants with BPD may be explained by several factors, including lower milk intake, impaired esophageal motility, and a peculiar autonomic nervous system response pattern.

PO-0599 Effects Of Non-nutritive Sucking On Gastroesophageal Reflux In Symptomatic Preterm Infants

<h3>Background</h3> The therapeutic management of gastroesophageal reflux (GER) in preterm infants still represents a controversial issue among neonatologists. To date, different non-pharmacological strategies, such as body positioning, milk thickening or changes of feeding modalities, have been proposed. However, the effects of non-nutritive sucking (NNS) on GER features, detected by multiple intraluminal impedance (MII), have not yet been evaluated in preterm newborns symptomatic for GER. <h3>Patients and methods</h3> Nineteen preterm newborns (GE ≤ 33 weeks) with GER symptoms underwent a 24-hours pH-MII monitoring. During this period, each infant received eight meals, four followed by NNS, applied by means of pacifier, and four not. Differences in GER features (number of episodes, acidity, duration and height reached) between NNS and non-NNS postprandial periods were evaluated by Wilcoxon signed-rank test. <h3>Results</h3> No significant difference in GER features between NNS and non-NNS periods was found. However, postprandial periods without NNS resulted in a slight increase in the mean duration of acid GER episodes (NNS vs. NON-NNS, median values: 51.15 vs. 88.20 sec, p 0.159). Consequently, during NNS periods the time of esophageal acid exposure was reduced (NNS vs. NON-NNS, median values: 3.54 vs. 6.15%, p 0.171). <h3>Conclusions</h3> According to our results, NNS administration during postprandial periods seems to have no significant effects on GER features in symptomatic preterm infants. However, during NNS periods we observed a slight, though not significant, reduction in the duration of acid GER, which plays a relevant role in the development of GERD. Further larger evaluations are needed to eventually confirm these preliminary data.

Effects of non-nutritive sucking on gastroesophageal reflux in symptomatic preterm infants

Objective: The therapeutic management of gastroesophageal reflux (GER) in the preterm population still represents a controversial issue among neonatologists. To date, different non-pharmacological strategies, such as body positioning, milk thickening or changes of feeding modalities, have been proposed; however, little is currently known on the role of non-nutritive sucking (NNS).

Assessment of red blood cell transfusion and transfusion duration on cerebral and mesenteric oxygenation using near‐infrared spectroscopy in preterm infants with symptomatic anemia

The aim of red blood cell (RBC) transfusion is to improve tissue oxygenation and relieve anemia-related symptoms in preterm infants. We sought to assess regional cerebral (rSO2 C) and mesenteric (rSO2 M) tissue oxygenation using a near-infrared spectroscopy (NIRS) method and vital signs (heart rate, arterial oxygen saturation, mean arterial blood pressure) in symptomatic preterm infants with anemia who received RBC transfusions. Twenty-three symptomatic patients with anemia who were at least 1 month old, whose gestational age was less than 30 weeks, and whose hematocrit level was not more than 27% were involved in the transfusion group. The control group consisted of preterm infants (Hct ≥ 32) matched for gestational age and postnatal days. The transfusion group was divided into two subgroups based on transfusion duration (2 or 4 hr). Both study groups were monitored for vital signs and rSO2 C, rSO2 M, and mesenteric-cerebral oxygenation ratio (MCOR) via NIRS for 24 hours simultaneously and compared with the control group. NIRS variables and vital signs obtained before, during, and after transfusion were compared both within and between 2- and 4-hour groups. rSO2 C, rSO2 S, and MCOR increased during and after transfusions, while cerebral fractional oxygen extraction (FOEC) and mesenteric fractional oxygen extraction (FOEM) decreased. No significant difference was found between subgroups for NIRS measurements and vital signs. A weak correlation between hemoglobin concentration and FOEC and FOEM was found. RBC transfusion improved cerebral-mesenteric oxygenation and MCOR in symptomatic infants with anemia, independent of the transfusion duration.

Extensively hydrolyzed protein formula reduces acid gastro-esophageal reflux in symptomatic preterm infants

BackgroundGastro-esophageal reflux (GER) is diagnosed frequently in preterm infants. Pharmacological treatment of GER has some potential side effects. Conservative treatment of GER should be the first-line approach and should include body positioning and diet modifications.Formula-fed preterm infants experience frequently symptoms of feeding intolerance. Hydrolyzed protein formula (HPF) is often used in these infants due to their effects on gastrointestinal motility. AimsTo investigate the role of an extensively HPF (eHPF) on GER indexes in formula-fed preterm infants with symptoms of both GER and feeding intolerance. Study designRandomized crossover trial SubjectsPreterm infants (gestational age ≤33weeks) with symptoms of feeding intolerance (large gastric residuals, abdominal distension and constipation) and GER (frequent regurgitations and/or postprandial desaturations). Outcome measuresGER indexes detected by 24-h combined multichannel intraluminal impedance and pH monitoring. GER indexes detected after 4 feeds of an eHPF were compared to those detected after 4 feeds of a standard preterm formula (SPF) by Wilcoxon signed ranks test. A p<0.05 was considered statistically significant. ResultseHPF significantly reduced the number of GERs detected by pH monitoring (p=0.036) and also the reflux index (p=0.044) compared to SPF. No differences in impedance bolus exposure indexes nor in GER height were detected. ConclusionsThe use of an eHPF should be evaluated for reducing esophageal acid exposure in preterm infants with feeding intolerance and symptoms of GER. Future research should focus on the evaluation of an eHPF adequate for preterm infants in improving clinical symptoms of GER.

622 Congenital Cystic Adenomatoid Malformation: is it Always Bad News?

AimTo evaluate whether conservative approach to management of asymptomatic neonates with antenatal diagnosis of congenital cystic adenomatoid malformation of the lungs (CCAM) is safe and appropriate.MethodWe undertook a retrospective review...

Lack of efficacy of a starch-thickened preterm formula on gastro-oesophageal reflux in preterm infants: a pilot study

Background: Gastro-oesophageal reflux (GOR) is common in preterm infants; conservative interventions (i.e. dietary changes) should represent the first-line approach. Aim: To evaluate by combined pH and impedance monitoring (pH-MII) the effect of a new preterm formula thickened with amylopectin (TPF) on GOR features in symptomatic preterm infants. Methods: Twenty-eight symptomatic preterm newborns underwent a 24-hour pH-MII; each baby received eight meals (four of TPF and four of a preterm formula [PF]). GOR indexes (number, acidity, duration and height of GORs) after TPF and PF meals were compared by Wilcoxon Signed Ranks Test. Viscosity of PF and TPF was measured. Results: TPF significantly decreased the number of acid GORs detected by pH-monitoring (TPF vs. PF: median 20 vs. 24.5, p = 0.009), while it had no influence on Reflux Index (RIpH), nor on acid and non-acid GOR indexes detected by MII, GOR physical features, and GOR height. TPF’s viscosity was extremely higher than PF’s, and further increased at pH 3 after the addition of pepsin. Conclusions: The new formula was found to reduce the number of acid GORs detected by pH-monitoring; it did not reduce neither total oesophageal acid exposure nor non-acid GORs. At present its extended clinical use cannot be recommended.

A19 Gastro-oesophageal reflux in symptomatic preterm infants: lack of efficacy of a new preterm thickened formula

A19 Gastro-oesophageal reflux in symptomatic preterm infants: lack of efficacy of a new preterm thickened formula

Clinical Characteristics and Genotypes of Rotaviruses in a Neonatal Intensive Care Unit

There are few reports on the symptoms of rotavirus infections in neonates. This study aims to describe clinical signs of rotavirus infections among neonates, with a particular focus on preterm infants, and to show the distribution of genotypes in a neonatal intensive care unit (NICU). A prospective observational study was conducted at a regional NICU for 1 year. Stool specimens from every infant in the NICU were collected on admission, at weekly intervals, and from infants showing symptoms. Rotavirus antigens were detected by enzyme-linked immunosorbent assay (ELISA), and genotypes were confirmed by Reverse transcription-Polymerase chain reaction (RT-PCR). The infants were divided into three groups: symptomatic preterm infants with and without rotavirus-positive stools [Preterm(rota+) and Preterm(rota-), respectively] and symptomatic full- or near-term infants with rotavirus-positive stools [FT/NT(rota+)]. Demographic and outcome data were compared among these groups. A total of 702 infants were evaluated for rotaviruses and 131 infants were included in this study. The prevalence of rotavirus infections was 25.2%. Preterm(rota+) differed from Preterm(rota-) and FT/NT(rota+) with respect to frequent feeding difficulty (p=0.047 and 0.034, respectively) and higher percentage of neutropenia (p=0.008 and 0.011, respectively). G4P[6] was the exclusive strain in both the Preterm(rota+) (97.7%) and FT/NT(rota+) (90.2%), and it was the same for nosocomial, institutional infections, and infections acquired at home. Systemic illness signs such as feeding difficulty and neutropenia are specific for preterm infants with rotavirus infections. G4P[6] was exclusive, regardless of preterm birth or locations of infections. This study might be helpful in developing policies for management and prevention of rotavirus infections in NICUs.

Transcatheter Occlusion of Patent Ductus Arteriosus in Pre-Term Infants

The aim of this study was to describe our institutional experience with transcatheter coil occlusion of patent ductus arteriosus (PDA) in symptomatic low birth weight pre-term infants. Transcatheter treatment of PDA in very small infants (<2 kg) is technically challenging and therefore often not considered as an alternative to traditionally accepted modalities (surgical or medical treatment). Coil occlusion was offered as an option to selected infants with symptomatic PDA. Case selection for the transcatheter procedure was determined by the patient's weight, PDA size, size of ampulla, and the anticipated coil mass required for complete closure (determined through echocardiography). The PDA occlusion was achieved with coils delivered with assistance of a 3-F bioptome. Arterial access and catheter manipulation within the cardiac chambers were avoided whenever feasible. Eight pre-term infants underwent coil occlusion. Gestational age ranged from 27 to 32 weeks (28.7 +/- 1.9 weeks). The median birth weight was 1,040 g (range 700 to 1,700 g), and the median weight at the time of procedure was 1,100 g (range 930 to 1,800 g). Three patients were receiving mechanical ventilation before intervention. Duct sizes ranged between 2 and 3.5 mm. Complete occlusion of the duct was instantly achieved in 7 patients, and 1 patient had a small residual flow for 24 h. There were no major procedure or access-related complications; 4 patients were discharged within 72 h; 1 patient was discharged on Day 10. Three patients required prolonged ventilation (34 and 150 days) due to pulmonary pathology. It is technically feasible to undertake transcatheter coil closure of PDA in carefully selected symptomatic pre-term infants, and it is a safe alternative to surgical ligation.

Packed Red Blood Cell Transfusion Increases Regional Cerebral and Splanchnic Tissue Oxygen Saturation in Anemic Symptomatic Preterm Infants

Preterm infants often receive multiple packed red blood cell (PRBC) transfusions that are intended to improve tissue oxygen levels. Near-infrared spectroscopy (NIRS) monitors regional cerebral tissue oxygen saturation (CrSO(2)) and splanchnic tissue oxygen saturation (SrSO(2)). Before such technology can be employed in neonatal transfusion management, it must first be established that transfusions result in an increase in tissue oxygen saturation. This prospective, observational study used NIRS to determine if PRBC transfusions increase the CrSO(2) and SrSO(2) of symptomatic anemic premature neonates. CrSO(2) and SrSO(2) values were compared for 20-minute duration immediately before, during, immediately after, and 12 hours after transfusion. As a secondary objective, CrSO(2) and SrSO(2) values were correlated with hemoglobin (Hgb) levels. One-way analysis of variance and Pearson correlation statistical tests were used for analysis. A statistically significant increase in CrSO(2) and SrSO(2) values were observed after transfusion in the 30 subjects included (CrSO(2): 62.8 +/- 1.6, 65.6 +/- 1.7, 68.0 +/- 1.3, 67.6 +/- 1.4, P < 0.001 and SrSO(2): 41.3 +/- 2.2, 46.7 +/- 3.0, 52.1 +/- 2.8, 48.2 +/- 2.5, P < 0.001). No correlation was found between CrSO(2) or SrSO(2) and Hgb values. NIRS identified increases in CrSO(2) and SrSO(2) in preterm neonates after PRBC transfusions and has the potential to become incorporated into neonatal transfusion management paradigms.

Protein Content and Fortification of Human Milk Influence Gastroesophageal Reflux in Preterm Infants

: Preterm human milk (HM) may provide insufficient energy and nutrients and thus may need to be fortified. Our aim was to determine whether fat content, protein content, and osmolality of HM before and after fortification may affect gastroesophageal reflux (GER) in symptomatic preterm infants. : Gastroesophageal reflux was evaluated in 17 symptomatic preterm newborns fed naïve and fortified HM by combined pH/intraluminal-impedance monitoring (pH-MII). Human milk fat and protein content was analysed by a near-infrared reflectance analysis. Human milk osmolality was tested before and after fortification. Gastroesophageal reflux indexes measured before and after fortification were compared and were also related to HM fat and protein content and osmolality before and after fortification. : An inverse correlation was found between naïve HM protein content and acid reflux index (RIpH: P = 0.041, rho =-0.501). After fortification, osmolality often exceeded the values recommended for infant feeds; furthermore, a statistically significant (P < 0.05) increase in nonacid reflux indexes was observed. : Protein content of naïve HM may influence acid GER in preterm infants. A standard fortification of HM may worsen nonacid GER indexes and, due to the extreme variability in HM composition, may overcome both recommended protein intake and HM osmolality. Thus, an individualised fortification, based on the analysis of the composition of naïve HM, could optimise both nutrient intake and feeding tolerance.

Combined oesophageal impedance‐pH monitoring in preterm newborn: comparison of two options for layout analysis

Gastro-oesophageal reflux (GOR) is common in preterm infants. Combined multichannel intraluminal impedance and pH monitoring (pH-MII) is emerging as an useful tool to study both acid and non-acid GOR in this population. We aimed to highlight main advantages and limits of pH-MII in preterm infants and to test whether the inclusion of GOR episodes detected only by pH monitoring details better the features of GOR. Fifty-two symptomatic preterm infants underwent a 24-hour, continuous and simultaneous measurement of pH-MII. Each layout was analyzed using two different options: option 1 included GOR episodes detected by MII and then classified as acid or non-acid according to the associated pH change; option 2 included GOR episodes detected by MII and also GOR episodes detected only by pH sensor. By adopting option 1, a total number of 2834 GOR episodes was detected by MII: 2162 of them were characterized as non-acid and 672 were characterized as acid. The median (range) number of acid MII-GOR episodes was 10 (1-52); the median (range) number of non-acid MII-GOR episodes was 36.5 (2-119). Median (range) acid MII-GOR-bolus exposure index was 0.28% (0.02-2.73%); median (range) non-acid MII-GOR-bolus exposure index was 1.03% (0.06-38.15%). By adopting option 2, an average of 53.2 acid GOR episodes and an average of 11% oesophageal exposure to acid GOR more than by option 1 was detected. An accurate and detailed description of GOR in preterm infants can be obtained only by including in the analysis all acid GOR episodes detected by pH sensor.