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Feeding resistance and gastroesophageal reflux in infancy
S F Dellert1, J S Hyams, W R Treem
1Department of Pediatrics, Hartford Hospital, Connecticut 06115.
Insights
Infant feeding resistance is an uncommon but severe issue linked to gastroesophageal reflux (GER). Infants with feeding resistance due to GER experienced more failure to thrive and required fundoplication surgery.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Nutrition
Background:
- Feeding resistance is a poorly understood complication of chronic gastroesophageal reflux (GER) in infants.
- Limited literature exists on the prevalence and clinical course of feeding resistance in infants with GER.
Purpose of the Study:
- To determine the prevalence and clinical course of feeding resistance in infants with chronic GER.
- To identify factors associated with feeding resistance in this population.
Main Methods:
- Retrospective review of clinical records of 600 infants (<24 months) with GER over 8 years.
- Exclusion of infants with severe neurological disease, craniofacial disorders, or prior esophageal surgery.
- Comparison of 25 infants with severe feeding resistance requiring tube feeding to age- and sex-matched controls with GER but no feeding resistance.
Main Results:
- 25 infants (4.2%) presented with severe feeding resistance requiring tube feeding.
- Feeding resistance occurred before GER diagnosis in 16 infants and during GER therapy in 9.
- Infants with feeding resistance showed significantly higher rates of failure to thrive and need for fundoplication compared to controls (p < 0.001).
- Mild neurodevelopmental delay was more common in the feeding resistance group, though not statistically significant (p = 0.08).
Conclusions:
- Feeding resistance is an uncommon but severe complication associated with infant GER.
- Failure to thrive and increased need for fundoplication are significant outcomes in infants with GER-related feeding resistance.
- Further research is warranted to understand the mechanisms and optimal management of feeding resistance in infants with GER.
Abstract:
Resistance to oral feedings occurring during the course of chronic gastroesophageal reflux (GER) in infants has received little attention in the literature. Accordingly, we reviewed the clinical courses of 600 infants of < 24 months of age with GER seen over an 8-year period to determine the prevalence and course of this problem. After excluding infants with severe neurologic disease, craniofacial disorders, or a history of esophageal surgery, 25 infants were found to have resistance to oral feedings that was severe enough to warrant tube feedings for nutritional support. Sixteen of these 25 infants had a history of resistance to oral feeding antedating a diagnosis of GER, whereas nine developed resistance to feeding during the course of therapy. Gestational age, age at onset of GER symptoms, severity of GER, presence/severity of esophagitis, type of medical therapy, need for fundoplication, or postfundoplication complications were similar in these two groups. When the clinical records of these 25 infants were compared to an age- and sex-matched infant population with GER but without feeding resistance, no differences were noted in severity of GER or the presence/severity of esophagitis. However, failure to thrive and the need for fundoplication were significantly more common in the feeding resistance group (p < 0.001). Among those infants with neurodevelopmental evaluation, mild delay was seen more commonly in the infants with feeding resistance but fell short of statistical significance (p = 0.08). Our observations suggest that resistance to oral feedings is an uncommon but severe problem associated with GER in infancy.(ABSTRACT TRUNCATED AT 250 WORDS)