TRANSPYLORIC TUBE FEEDING IN VERY LOW BIRTHWEIGHT INFANTS WITH SUSPECTED GASTROESOPHAGEAL REFLUX: IMPACT ON APNEA AND BRADYCARDIA

OBJECTIVE: Our aim was to assess safety and efficacy of transpyloric tube feeding as a therapeutic option to reduce apnea and bradycardia in hospitalized very low birthweight infants with clinical signs suggestive of gastroesophageal reflux. PATIENTS AND METHODS: This was a retrospective single center cohort study of VLBW infants hospitalized from 2001–2004 with signs of GER who received transpyloric enteral tube feedings. Apnea (>10 sec) and bradycardia (<100 bpm) episodes were compared before and after the initiation of transpyloric feedings. The Wilcoxon signed-rank test was used to compare differences between cardio-respiratory episodes before and after treatment at 1-day and combined 3-day intervals. Events recorded to assess safety of transpyloric feedings included death, sepsis, and necrotizing enterocolitis. RESULTS: 72 VLBW infants with a median birth weight of 870 grams (range 365–1435g) and gestational age of 26 weeks (23–31weeks) were identified. Median weight at initiation of transpyloric feedings was 1297 grams (820–3145g) and infants received transpyloric feeds for median duration of 18 days (1–86days). After initiation of transpyloric feedings, a reduction in apnea episodes from 4.0 to 2.5 (P=0.02) and a decrease in bradycardia episodes from 7.2 to 4.5 (P<0.001) was observed when comparing total number of episodes for the 3 days before and after treatment. Five (6.9%) of the infants developed necrotizing enterocolitis while receiving transpyloric feedings. None of the infants receiving human milk (P=0.07) and 36% of those receiving hydrolysate based formula (P<0.01) during transpyloric feeds developed NEC. No infants had late-onset culture proven sepsis. Seven (9.7%) infants died prior to hospital discharge. CONCLUSIONS: Transpyloric feedings, especially when limited to human milk, may safely reduce episodes of apnea and bradycardia in preterm infants with suspected gastroesophageal reflux. Prospective randomized studies are needed to determine the biologic impact of bypassing the stomach, as well as the safety and efficacy of this intervention. Results of such studies could modify the current prevailing safety concerns regarding transpyloric feeding in this population.