328 - Impact of Intraventricular Hemorrhage on Gastroesophageal Reflux Characteristics Using pH-Multi-Channel Impedance Methods in Premature Infants

Publication Number: 328.5503

Jenny Bellodas Sanchez, Nationwide Children's Hospital/Ohio State University College of Medicine, Blacklick, OH, United States; Zakia Sultana, Nationwide Children's Hospital, Columbus, OH, United States; Narmada Pinnamraju, Nationwide Children's Hospital, Columbus, OH, United States; Enas Alshaikh, Nationwide Children's Hospital, columbus, OH, United States; Sudarshan R. Jadcherla, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States

Background: Prematurely born infants are at increased risk for acute and chronic neuropathology from intraventricular hemorrhage (IVH) and related consequences. Convalescing infants often manifest with immaturity or maladaptation of peristaltic reflexes and aerodigestive protective mechanisms that result in oral and enteral feeding difficulties. These troublesome airway-, digestive- and somatic symptoms may masquerade as gastroesophageal reflux (GER) or GER disease (GERD), and empiric treatment with acid-suppression, thickened feeds and gastrostomy with fundoplication are implemented. Understanding the relationship between neuropathology and GERD is important to provide accurate diagnoses and guide targeted therapies.

Objective: 1) To characterize the frequency and types of GER events, and their relationship with symptom-types among enterally fed symptomatic prematurely born infants in the neonatal ICU. 2) To compare pH-impedance patterns and symptom characteristics in infants with varying severities of IVH.

Design/Methods: A total of 146 neonates (27.8 ± 0.26 weeks gestation) with 4 different IVH grades were evaluated for troublesome GER symptoms using 24-hour pH-impedance at 42.6 ± 0.36 weeks postmenstrual age. List of variables analyzed are shown in Table 1. Frequency of overall and individual symptoms, and symptom association probability (SAP) were also analyzed. Analysis of Variance (ANOVA) was used to compare characteristics across the 4 IVH severity grades. Bonferroni adjustment was used for post-hoc comparison.

Results: Comparison of pH-impedance and symptom characteristics are shown in Table 1. Infants with Grade 4 IVH had greater number of acid reflux periods, acid only events, acid reflux events, total symptoms and individual symptoms of arching/irritability, and cough when compared to Grade 1 IVH. No significant differences were noted between the remaining IVH severity grades. Infants with Grade 4 IVH had more airway-, digestive- and somatic symptoms than those with lesser degree of IVH.

Conclusion(s): Premature infants with Grade 4 IVH showed abnormal pH-impedance patterns compared to those with Grade 1. GERD symptoms increased in parallel to the IVH severity. Findings could suggest that IVH affect vagal nerve mediated esophageal peristaltic and sphincteric functions and aerodigestive reflexes, leading to troublesome symptoms. Therefore, infants with neuropathology could benefit from specialized assessment to guide targeted therapies.

Table 1: Gastroesophageal reflux and symptoms characteristics using 24-hour pH-impedance study in infants with Intraventricular Hemorrhage
Data presented as mean ± SE, or n (%). Asterisk (*) and bold values highlights the statistically significant difference (P < 0.05) between Grade 4 vs Grade 1. No other differences were noted between groups when compared with Grade 1.