Pilot Study of Inclined Position and Infant Gastroesophageal Reflux Indicators

JPGN Reports · 5 authors, 3 centres

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TL;DR

This pilot study observed 25 infants with GERD and 10 controls in a reclining device at four different head elevations (0°, 10°, 18°, 28°) after a feed. It found that brief episodes of hypoxia, bradycardia, and regurgitation are common in infants with GERD regardless of the angle of incline, with no statistically significant differences in outcomes between positions.

Full summary

581 CHARS

This exploratory pilot study enrolled 25 infants with GERD and 10 healthy controls for a post-feed observation session. Infants were randomized to consecutive 15-minute periods in a reclining device at four different head elevations: 0°, 10°, 18°, and 28°. Continuous pulse oximetry monitored for hypoxia and bradycardia, while coordinators recorded regurgitation episodes and other symptoms. Mothers rated infant comfort. Among infants with GERD, the study found that brief episodes of hypoxia (80 episodes), bradycardia (33 episodes), and regurgitation (28 episodes) were common.

STUDY TYPE

cohort

SPECIALTY

pediatrics

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ORIGINAL PAPER

PMC10187856

Pilot Study of Inclined Position and Infant Gastroesophageal Reflux Indicators

JPGN Reports

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ABSTRACT

Objective: To reduce gastroesophageal reflux, infants are commonly placed in an inclined position. We sought to observe the extent to which infants exhibit (1) oxygen desaturation and bradycardia in supine and inclined positions and (2) signs and symptoms of post-feed regurgitation in these positions. Study Design: Healthy infants aged 1–5 months with gastroesophageal reflux disease (GERD) (N = 25) and controls (N = 10) were enrolled into one post-feed observation. Infants were monitored in a prototype reclining device for consecutive 15-minute periods in supine position with head elevations of 0°, 10°, 18°, and 28° in random order. Continuous pulse oximetry assessed hypoxia (O 2 saturation <94%) and bradycardia (heart rate <100). Regurgitation episodes and other symptoms were recorded. Mothers assessed comfort using an ordinal scale. Incident rate ratios were estimated using Poisson or negative binomial regression models. Results: Among infants with GERD, in each position, most had no episodes of hypoxia, bradycardia, or regurgitation. Overall, 17 (68%) infants had 80 episodes of hypoxia (median 20 seconds duration), 13 (54%) had 33 episodes of bradycardia (median 22 seconds duration), and 15 (60%) had 28 episodes of regurgitation. For all 3 outcomes, incident rate ratios were not significantly different between positions, and no differences were discovered for observed symptoms or infant comfort. Conclusions: Brief episodes of hypoxia and bradycardia as well as observed regurgitation are common for infants with GERD placed in the supine position after a feed with no differences in outcomes at various degrees of head elevation. These data may be used to power future, larger, and longer evaluations. ClinicalTrials.gov Identifier: NCT04542239 .

CITATION EXPORT

Ian M. Paul, Katherine E. Shedlock, Eric W. Schaefer et al.. Pilot Study of Inclined Position and Infant Gastroesophageal Reflux Indicators. JPGN Reports. (2023). https://doi.org/10.1097/PG9.0000000000000312

AUTHORS

5 · 3 CENTRES

Ian M. Paul, Katherine E. Shedlock, Eric W. Schaefer, Ellen J. Stoute, Rachel Rosen

From the *Pediatrics, Penn State College of Medicine, Hershey, PA
†Public Health Sciences, Penn State College of Medicine, Hershey, PA
‡Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, MA.