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Antireflux surgery in infants with bronchopulmonary dysplasia
Insights
Fundoplication-gastrostomy surgery improved respiratory and nutritional outcomes for infants with severe bronchopulmonary dysplasia and gastroesophageal reflux. This procedure reduced oxygen needs and enhanced growth, facilitating easier feeding and hospital discharge.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Infants with severe bronchopulmonary dysplasia (BPD) and gastroesophageal reflux (GER) often experience failure to thrive.
- These infants typically require mechanical ventilation and present significant feeding challenges.
Purpose of the Study:
- To evaluate the efficacy of fundoplication-gastrostomy surgery in managing severe BPD and GER in infants.
- To assess the impact of the procedure on respiratory status, nutritional intake, and overall clinical outcomes.
Main Methods:
- Retrospective review of medical records for nine infants undergoing fundoplication-gastrostomy.
- Analysis of preoperative, operative, and postoperative data including ventilation requirements, oxygen dependence, feeding tolerance, and growth velocity.
Main Results:
- The surgery was well-tolerated, with significant reductions in fractional inspired oxygen concentration (FiO2) by 30 and 180 days postoperatively (0.14 and 0.22 decrease, respectively).
- All infants achieved successful gastrostomy feeding by postoperative day 4 with no clinical reflux, and demonstrated a doubling of growth velocity within 180 days.
- Two patients experienced postoperative mortality due to cardiorespiratory failure; seven were extubated by day 11.
Conclusions:
- Fundoplication-gastrostomy is an effective intervention for infants with severe BPD and GER.
- The procedure facilitates improved respiratory function, promotes nutritional rehabilitation and catch-up growth, and simplifies feeding management.
Abstract:
We reviewed the medical records of nine infants with severe bronchopulmonary dysplasia and gastroesophageal reflux who underwent fundoplication-gastrostomy surgery. All the infants were born prematurely, required preoperative mechanical ventilation, and were failing to thrive. The operative procedure was well tolerated by all the infants. Seven patients were extubated by day 11, and two patients required long-term ventilation. There were two postoperative deaths, both attributed to acute respiratory deterioration followed by cardiorespiratory failure. The postsurgical respiratory response was observed to be a rapid decrease in oxygen requirements and an absence of further aspiration episodes. A mean decrease of 0.14 in fractional inspired oxygen concentration was noted by 30 days postoperatively, and by 180 days the decrease in fractional inspired oxygen concentration was 0.22. All infants were fed by gastrostomy by postoperative day 4, with no evidence of clinical reflux. The nutritional response was noted to be an increase in growth velocity with increasing age (ie, catch-up growth) and ease of feeding. At both 30 and 180 days postoperatively, the mean growth velocity was more than double the preoperative growth velocity. In addition, ease of postoperative feeding reduced the nursing care requirements and allowed earlier discharge from hospital. Fundoplication and gastrostomy is effective in facilitating growth and feeding in addition to decreasing oxygen requirements in infants with severe bronchopulmonary dysplasia and gastroesophageal reflux.