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Feeding disorders and gastroesophageal reflux in infants with chronic renal failure
E J Ruley1, G H Bock, B Kerzner
1Department of Nephrology, Children's Hospital National Medical Center, George Washington University School of Medicine, Washington, DC 20010.
Insights
Gastroesophageal reflux is common in infants with chronic renal failure, contributing to feeding difficulties. This condition impacts nutrition and growth in these vulnerable children.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Clinical Nutrition
Background:
- Infants with chronic renal failure (CRF) often exhibit poor nutrition, growth failure, and feeding issues.
- Malnutrition and underweight are prevalent in this patient population.
- Upper gastrointestinal dysfunction is a suspected contributor to these problems.
Purpose of the Study:
- To investigate the role of upper gastrointestinal function, specifically gastroesophageal (GE) reflux, in infants with chronic renal failure (CRF).
- To assess the nutritional status, growth, and feeding challenges in these infants.
Main Methods:
- Study included 22 infants with CRF (mean age 7.5 months).
- Evaluated nutrition, growth, and upper gastrointestinal function.
- Utilized 24-h esophageal pH monitoring and gastroesophageal scintiscans to detect GE reflux.
- Assessed caloric and protein intake, nutritional status, and need for supplemental feeding (SF).
Main Results:
- 73% of infants with CRF (16/22) demonstrated significant GE reflux via pH monitoring.
- Infants with GE reflux were younger and more frequently required SF.
- Gastroesophageal scintiscans showed lower sensitivity and specificity for reflux detection compared to pH monitoring.
- No significant differences in renal failure severity, growth, or nutritional status were found between infants with and without GE reflux.
Conclusions:
- Gastroesophageal (GE) reflux is a significant factor contributing to feeding problems in infants with chronic renal failure (CRF).
- Consideration of GE reflux is crucial for managing feeding difficulties in pediatric patients with CRF.
- Further investigation into the interplay between CRF and GE reflux is warranted.
Abstract:
Twenty-two infants (mean age 7.5 months) with chronic renal failure (CRF) were studied for their nutrition, growth, and upper gastrointestinal function. Most infants had a history of poor caloric intake and 7 had received supplemental feeding (SF) prior to the investigation. All infants were undergrown, underweight, and malnourished. The infants were characterized as having only a fair interest in food, refusing feedings, and vomiting excessively. Sixteen of 22 infants (73%) had significant gastroesophageal (GE) reflux demonstrated by 24-h esophageal pH monitoring. Gastroesophageal scintiscans were less sensitive and specific in detecting the reflux. Infants with GE reflux were significantly younger and more often required SF than those without GE reflux. There were no significant differences in the degree of renal failure, growth failure, caloric intake, protein intake, or nutritional status between the infants with and without GE reflux. From these studies we conclude that GE reflux should be considered as one of the factors contributing to the feeding problems of infants with CRF.