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Time-wise sequential analysis of gastric aspirate for occult blood and pH in sick preterm infants
Insights
Critically ill preterm infants experienced lower gastric pH levels compared to those with mild hyaline membrane disease. Gastric pH progressively decreased over time, correlating with occult gastric blood loss in neonates.
Area of Science:
- Neonatalogy
- Gastroenterology
- Critical Care Medicine
Background:
- Advancements in care and technology improve survival rates for low birthweight infants.
- These infants often require parenteral nutrition initially due to inability to feed orally.
- Monitoring gastric pH and blood loss is crucial for managing critically ill neonates.
Purpose of the Study:
- To evaluate sequential changes in gastric pH and occult blood loss in two groups of low birthweight infants.
- To compare gastric pH and blood loss between infants with mild and severe hyaline membrane disease.
- To investigate the association between decreasing gastric pH and occult blood loss.
Main Methods:
- Gastric contents were sampled from low birthweight infants via orogastric tubes every 4-6 hours.
- Group 1: 7 infants (mild hyaline membrane disease), Group 2: 9 infants (severe hyaline membrane disease requiring ventilation).
- Gastric pH and occult blood loss were assessed over 7 days (Group 1) and 14 days (Group 2).
Main Results:
- Critically ill preterm infants (Group 2) exhibited significantly lower gastric pH than Group 1 (p < 0.015).
- A progressive decrease in gastric pH was observed in both groups over time (P < 0.001).
- Occult gastric blood loss was associated with a mean gastric pH of 2 +/- 0.1.
Conclusions:
- Critically ill preterm infants with severe hyaline membrane disease have lower gastric pH.
- Gastric pH decreases progressively in low birthweight infants, irrespective of disease severity.
- A low gastric pH is linked to occult gastric blood loss in neonates.
Abstract:
Improvements in both care and technology have led to the survival of more low birthweight infants. Initially, these infants are not fed orally and are placed on parenteral nutrition. In an attempt to evaluate sequential time-wise changes in gastric pH and occult blood loss, evaluation of gastric pH and tests for the presence of blood in the gastric aspirate were carried out in two groups of infants. Group 1 consisted of seven cases, three males and four females, with a mean +/- SE gestation of 29.9 +/- 0.8 weeks and a birthweight of 1410 +/- 190 g. Group 2 consisted of nine cases, three males and six females, with a mean +/- gestation of 28.6 +/- 0.84 weeks and a birthweight of 940 +/- 120 g. Gastric contents were sampled through indwelling orogastric tubes every 4-6 h daily for the first seven days in Group 1 and 14 days in Group 2. Infants in Group 1 were spontaneously breathing with mild hyaline membrane disease (HMD) whereas Group 2 infants had severe HMD requiring ventilation. Results indicate that critically ill preterm infants (Group 2) had significantly lower pH when compared to Group 1 (p less than 0.015). Progressive decrease in pH was observed in both groups (P less than 0.001). The association of occult gastric blood loss with decreasing pH was examined using pooled data from both groups of neonates. During the times when bleeding occurred, the mean +/- SE gastric pH level was 2 +/- 0.1.(ABSTRACT TRUNCATED AT 250 WORDS)