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Does mechanical ventilation precipitate gastro-oesophageal reflux during enteral feeding?

S J Newell1, M E Morgan, G M Durbin

  • 1Institute of Child Health, University of Birmingham.

Archives of Disease in Childhood
|October 1, 1989
PubMed

Insights

Intermittent positive pressure ventilation significantly reduced gastro-oesophageal reflux in preterm infants. This finding suggests that enteral feeding can continue during ventilation, addressing concerns about aspiration.

Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Respiratory Physiology

Background:

  • Gastro-oesophageal reflux (GOR) is a concern in preterm infants, potentially leading to aspiration.
  • Ventilatory support in neonates may be avoided due to fears of exacerbating GOR and aspiration.
  • Enteral feeding is often withheld during mechanical ventilation in neonatal intensive care units.

Purpose of the Study:

  • To investigate the influence of intermittent positive pressure ventilation (IPPV) on GOR in enterally fed preterm infants.
  • To determine if IPPV affects the frequency or severity of gastro-oesophageal reflux.
  • To assess the safety of continuing enteral feeding during IPPV.

Main Methods:

  • A crossover study design was employed.
  • Lower oesophageal pH monitoring was used to quantify gastro-oesophageal reflux.
  • Nine enterally fed, very low birthweight infants were studied during both IPPV and normal breathing.

Main Results:

  • Infants exhibited significantly less gastro-oesophageal reflux during IPPV (mean reflux index 2.3%) compared to normal breathing (mean reflux index 6.1%).
  • IPPV was associated with a reduction in the gastro-oesophageal pressure gradient.
  • Positive end-expiratory pressure (PEEP) during ventilation may contribute to the observed reduction in reflux.

Conclusions:

  • Concerns regarding increased gastro-oesophageal reflux during ventilation should not prevent enteral feeding in preterm infants.
  • IPPV may actually reduce gastro-oesophageal reflux in this vulnerable population.
  • Continuing enteral nutrition during mechanical ventilation is supported by these findings.

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