PubMed · 91725
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1979-11-10. Drug absorption: the solution is solution.. https://pubmed.ncbi.nlm.nih.gov/91725/
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The gastric residual (GR) volume was measured in 50 healthy preterm babies, 38 appropriate-for-dates (AFD), and 12 small-for-dates (SFD) with gestational age of 28-36 weeks. The mean basal 4-hour gastric residual (B4 GR) volume was 2.8 +/- 0.63 ml in parenterally fed babies. There was a marked decrease in the residuals from 20.7 +/- 15.2 per cent (mean +/- SD) on day 4 to 8.6 +/- 4.3 per cent on day 7 (P < 0.001). Of the 27 infants fed with expressed breastmilk (EBM), mean GR was 24.4 +/- 10.2 per cent in supine and 12.8 +/- 4.3 per cent in prone position (P < 0.01). Twenty-one babies nursed in the prone position showed a mean GR volume of 12.8 +/- 4.3 per cent with EBM and 13.6 +/- 2.7 per cent with milk formula. No difference was noted in the gastric residuals of AFD v. SFD babies. No linear correlation was found between increase in abdominal girth and GR. However, if the increase in abdominal girth was at least 2 cm or more, a GR of 23 per cent or more was observed. This should be taken as warnings to reduce or withhold oral feeds.
We have applied ultrasonography to the evaluation of gastric emptying in children. Two different populations have been investigated: normal children and children with gastroesophageal reflux. All the patients were less than 6 months of age. The diagnosis of gastroesophageal reflux was defined by 24-h pH measurement. The technique, used to measure gastric emptying, is the one described by Bolondi et al. In this research we used the simplified method. All children had been submitted to the examination after 4-h fasting. The standard meal was the usual milk formula, 300 ml/m2 body surface area (BSA). A cross-section area of the gastric antrum was determined before a meal and every 15 min for 2 h. The examination was concluded after two measurements were equal to the basal one. The normal gastric emptying curve was determined by a control group. Patients with gastroesophageal reflux showed three different kind of gastric emptying: (a) normal gastric emptying in 20% of cases, (b) abnormal gastric emptying in 15% of cases, and (c) intermediate cases in which the plateau curve is abnormal but the end time of gastric emptying is normal. We defined these three kinds of curves as type I or normal, type III or abnormal, and type II or intermediate. The estimate of frequency in patients with gastroesophageal reflux is similar to the reported data of the literature.
The role of delayed gastric emptying (GE) in the pathogenesis of gastroesophageal reflux (GER) in infants is controversial at present. GE has been shown to be altered by the composition and osmolality of the feedings. This prospective study was undertaken to assess the changes in the GE and the percentage of time GER was detected by scintigraphy using three different formulas on consecutive days in infants with GER. Twenty-eight infants under 1 year of age diagnosed to have GER by extended intraesophageal pH monitoring (pH being less than 4.0 for greater than 5% of the duration of the test), underwent scintigraphy on three consecutive days using the same volume per single feeding of a casein-predominant, soy, or a whey-hydrolysate formula in a randomized order. The formulas were isocaloric. Gastric emptying and percentage of GER into the esophagus were estimated for 60 min following these feedings. Mean GER percent during the study was 20.39, 17.68, and 16.34 on casein-predominant, soy, and whey-hydrolysate formulas, respectively, and was not significantly different. Mean values of GE were 39.7%, 44.6%, and 48.5% on casein, soy, and whey formula, respectively. No significant difference in GE was also observed between casein-predominant and soy formula. However, a significant difference was observed (p less than 0.05) on GE between casein-predominant and whey-hydrolysate feedings. Our data suggest that formula selection may be important in the treatment of conditions associated with delayed gastric emptying.