Characterization of esophageal body and lower esophageal sphincter motor function in the very premature neonate,☆☆,

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Abstract

Objectives: To characterize esophageal body and lower esophageal sphincter (LES) motor function in very premature infants. Study design: Esophageal manometry was performed in 12 very premature infants of 26 to 33 weeks’ postmenstrual age (PMA) (body weights of 610-1360 g). Esophageal motor patterns were recorded for 30 minutes with a perfused micromanometric sleeve assembly (outer diameter, 2.0 mm). Results: Esophageal pressure waves triggered by dry swallows were predominantly (84%) peristaltic in propagation sequence. All infants showed tonic LES contraction; the mean resting LES pressure (LESP) for individual infants ranged from 5.0 ± 4.1 mm Hg to 20.0 ± 4.8 mm Hg. In all infants the LES relaxed (duration, 5.8 ± 3.0 seconds; nadir pressure, 1.8 ± 2.6 mm Hg) in response to pharyngeal swallows. Transient LES relaxations (TLESRs) (duration, 21.7 ± 8.7 seconds; nadir pressure, 0.1 ± 1.8 mm Hg) occurred on average 2.6 ± 1.6 times per study; 86% of these relaxations triggered esophageal body common cavity events known to be associated with gastroesophageal reflux. Conclusions: Esophageal motor function is well developed in very premature infants. Our data also suggest that TLESR is the predominant mechanism of reflux in these babies. (J Pediatr 1999;135:517-21)

Section snippets

Subjects

Studies were performed in 12 (5 male and 7 female) tube-fed preterm infants with a mean PMA of 30 weeks (range, 26-33 weeks). PMA was calculated by adding postnatal age (5-43 days; mean, 18 days) to the gestational age (25-31 weeks; mean, 27 weeks), which was determined from both maternal history of last menstrual period and early ultrasonography at <19 weeks. Mean infant birth weight was 854 g (range, 580-1260 g), and mean weight on the day of study was 960 g (range, 610-1360 g). At the time

RESULTS

The procedure was well tolerated by all infants studied, and no complications were observed. In one study only resting LESP data were analyzed because of the absence of a reliable swallow signal. All other studies were technically satisfactory. The Figure shows a manometric tracing of esophageal motility that was recorded in the most premature infant studied (26 weeks’ PMA; body weight, 610 g) and illustrates the most common esophageal motor events observed in all babies.

Figure. Tracing of

DISCUSSION

In infants with an average weight below 1000 g, who are categorized as very low to extremely low birth weight, esophageal and LES motor patterns are almost identical to those recorded previously in much older and healthier premature infants with similar techniques.1, 2, 4 In addition, TLESR was recorded in all infants and was a predominant mechanism of manometrically identified GER episodes.

The esophageal body motor patterns recorded in this study further confirm that although premature infants

Acknowledgements

We thank Mrs Ros Lontis, Mrs Louise Goodchild, and Mr Antonie Snel for making this study possible by recruiting patients and providing specialized nursing care at the bedside; Dr Charles Malbert for the computerized data acquisition and analysis software used; and Mr Malcolm Bakewell for providing invaluable technical support.

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    Supported by National Health and Medical Research Council of Australia and Women’s and Children’s Hospital Research Foundation. Dr Benninga’s involvement in this project was supported by the Ter Meulen Fund, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands, the Netherlands Organisation for Scientific Research and the Netherlands Digestive Diseases Foundation.

    ☆☆

    Reprint requests: Taher I. Omari, BSc, PhD, Gastroenterology Unit, Women’s and Children’s Hospital, 72 King William Rd, North Adelaide, Australia 5006.

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