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Early feeding resistance: a possible consequence of neonatal oro-oesophageal dyskinesia
1Department of Paediatrics, Hĵpital Necker-Enfants Malades, Paris, France. veronique.abadie@nck.ap-hop-paris.fr
Insights
Infants with unexplained feeding issues may have neonatal oro-oesophageal dyskinesia, a temporary condition affecting esophageal function. This condition often resolves by the first year, with improved feeding and weight gain.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Developmental Pediatrics
Background:
- Feeding disorders in neonates and infants are common, often presenting with poor weight gain and no clear organic cause.
- Unexplained poor feeding skills and excessive regurgitation have been observed in infants for many years.
- Identifying the underlying causes of these feeding difficulties is crucial for appropriate intervention.
Purpose of the Study:
- To investigate the potential link between unexplained feeding disorders in infants and esophageal manometry findings.
- To characterize the clinical presentation and manometric abnormalities in infants with poor feeding and growth failure.
- To explore the long-term outcomes of infants diagnosed with feeding difficulties and esophageal dysmotility.
Main Methods:
- Prospective esophageal manometry was performed in infants hospitalized for retarded growth and unexplained feeding disorders from 1992 to 1997.
- A cohort of 16 infants with abnormal feeding behavior and abnormal esophageal manometry was identified.
- Manometric data were compared with a control group of 16 age-matched infants who underwent esophageal manometry for other reasons.
Main Results:
- 16 infants (3%) presented with abnormal feeding behavior and abnormal esophageal manometry.
- Affected infants exhibited prolonged bottle-feeding, bottle refusal, unexplained crying, and excessive regurgitation.
- Esophageal manometry revealed lower esophageal sphincter hypertonia and/or partial failure to relax, and giant esophageal body waves in 70% of cases.
Conclusions:
- The study suggests that early feeding resistance in this group of children may be related to organic and transient neonatal oro-esophageal dyskinesia.
- Feeding difficulties generally decreased around the end of the first year, coinciding with the acquisition of normal voluntary mastication.
- Neonatal oro-esophageal dyskinesia is a potential, albeit transient, cause of unexplained feeding disorders in infants.
Unlabelled:
Paediatricians frequently find early feeding disorders in neonates and infants that result in poor weight gain and which sometimes have no clear organic basis. For many years, we have observed infants with unexplained poor feeding skills and excessive regurgitation, and since 1992 we have prospectively performed oesophageal manometry in infants hospitalized for retarded growth and "unexplained" feeding disorders. From the group of infants hospitalized for growth failure in the General Paediatric Unit of Necker-Enfants Malades Hospital from 1992 to 1997, we identified 16 children (3%) with abnormal feeding behaviour who had an abnormal oesophageal manometry. The manometric data of these children were compared with those of a group of 16 age-matched children who underwent oesophageal manometry for other reasons, and served as controls. The affected children had precocious feeding skills disorders: prolonged bottle-feeding (75%), bottle refusal (75%), unexplained crying (63%) and excessive regurgitation (94%). Half of them had mild anatomical facial consequences of their poor foetal sucking, and mild pharyngolaryngeal hypotonia, which could not be considered as malformations. Apart from these disorders, their clinical status was normal. At inclusion, their oesophageal manometry was abnormal, showing in 70% of cases specific anomalies: lower oesophageal sphincter hypertonia and/or partial failure to relax, and giant waves of oesophagus body. Their course was good and their feeding difficulties decreased around the end of the first year, with the acquisition of normal voluntary mastication.
Conclusion:
We suggest that the early feeding resistance of this group of children could be related to an organic and transient neonatal oro-oesophageal dyskinesia.