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      Nutritional Intervention of a Pediatric Patient with Congenital Bronchomalacia and Gastroesophageal Reflux Disease: a Case Report

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          Abstract

          Gastroesophageal reflux disease (GERD) is closely related to respiratory issues. We reported the case about the nutrition intervention given to a male infant with congenital bronchomalacia, GERD, and recurrent pneumonia. During the first and second pediatric intensive care unit (PICU) stays, his nutrition status and nutrient intake were good. However, during the 18 days of the third PICU admission, his nutrient intake decreased to 75%–80% of his estimated calorie requirement and his Z-score for weight-for-age dropped to −1.4. We conducted nutritional interventions to improve GERD symptoms and nutritional status include avoiding overfeeding by feeding small amounts frequently, using a pre-thickened formula mixed with a high-calorie formula, and feeding through transpyloric tube. As a result, his daily nutrient intakes gradually increased and his Z-score for weight-for-age was normal. In conclusion, it is important to implement individualized intensive nutritional management to ensure adequate nutrition and growth status in infants with lung disease and GERD.

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          Most cited references7

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          European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment

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            The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials.

            Currently, thickened feeds are increasingly being used to treat infants with gastroesophageal reflux, driven in large part by the baby food industry. Previous meta-analyses have shown that although thickened formulas do not seem to reduce measurable reflux, they may reduce vomiting. However, because data are limited, there is still uncertainty regarding the use of thickening agents.
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              TRANSPYLORIC TUBE FEEDING IN VERY LOW BIRTHWEIGHT INFANTS WITH SUSPECTED GASTROESOPHAGEAL REFLUX: IMPACT ON APNEA AND BRADYCARDIA

              OBJECTIVE Our aim was to assess safety and efficacy of transpyloric tube feeding as a therapeutic option to reduce apnea and bradycardia in hospitalized very low birthweight infants with clinical signs suggestive of gastroesophageal reflux. PATIENTS AND METHODS This was a retrospective single center cohort study of VLBW infants hospitalized from 2001–2004 with signs of GER who received transpyloric enteral tube feedings. Apnea (>10 sec) and bradycardia (<100 bpm) episodes were compared before and after the initiation of transpyloric feedings. The Wilcoxon signed-rank test was used to compare differences between cardio-respiratory episodes before and after treatment at 1-day and combined 3-day intervals. Events recorded to assess safety of transpyloric feedings included death, sepsis, and necrotizing enterocolitis. RESULTS 72 VLBW infants with a median birth weight of 870 grams (range 365–1435g) and gestational age of 26 weeks (23–31weeks) were identified. Median weight at initiation of transpyloric feedings was 1297 grams (820–3145g) and infants received transpyloric feeds for median duration of 18 days (1–86days). After initiation of transpyloric feedings, a reduction in apnea episodes from 4.0 to 2.5 (P=0.02) and a decrease in bradycardia episodes from 7.2 to 4.5 (P<0.001) was observed when comparing total number of episodes for the 3 days before and after treatment. Five (6.9%) of the infants developed necrotizing enterocolitis while receiving transpyloric feedings. None of the infants receiving human milk (P=0.07) and 36% of those receiving hydrolysate based formula (P<0.01) during transpyloric feeds developed NEC. No infants had late-onset culture proven sepsis. Seven (9.7%) infants died prior to hospital discharge. CONCLUSIONS Transpyloric feedings, especially when limited to human milk, may safely reduce episodes of apnea and bradycardia in preterm infants with suspected gastroesophageal reflux. Prospective randomized studies are needed to determine the biologic impact of bypassing the stomach, as well as the safety and efficacy of this intervention. Results of such studies could modify the current prevailing safety concerns regarding transpyloric feeding in this population.
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                Author and article information

                Journal
                Clin Nutr Res
                Clin Nutr Res
                CNR
                Clinical Nutrition Research
                Korean Society of Clinical Nutrition
                2287-3732
                2287-3740
                October 2019
                28 October 2019
                : 8
                : 4
                : 329-335
                Affiliations
                [1 ]Department of Nutrition Care, Severance Hospital, Yonsei University Health System, Seoul 03772, Korea.
                [2 ]Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea.
                Author notes
                Correspondence to Hosun Lee. Department of Nutrition Care, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03772, Korea. hslee0730@ 123456yuhs.ac
                Author information
                https://orcid.org/0000-0003-1507-2413
                https://orcid.org/0000-0003-4529-6135
                https://orcid.org/0000-0001-7313-0242
                https://orcid.org/0000-0003-4965-6193
                https://orcid.org/0000-0002-5634-9709
                https://orcid.org/0000-0002-2478-487X
                https://orcid.org/0000-0003-0811-1314
                Article
                10.7762/cnr.2019.8.4.329
                6826054
                821a01ed-5c2f-4770-bc26-ad721ed73e11
                Copyright © 2019. The Korean Society of Clinical Nutrition

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 October 2019
                : 22 October 2019
                : 23 October 2019
                Categories
                Case Report

                gerd,pneumonia,enteral nutrition,infant
                gerd, pneumonia, enteral nutrition, infant

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