64 - Direct Effects of Added Rice Formula on pH-Impedance Characteristics in Hospitalized Infants Suspected to have Gastroesophageal Reflux Disease

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 64
Publication Number: 64.215

Minna Njeh, Nationwide Children's Hospital, Columbus, OH, United States; Zakia Sultana, Nationwide Children's Hospital, Columbus, OH, United States; Kathryn A.. Hasenstab, Nationwide Children's Hospital, Columbus, OH, United States; Toni D. Plumb, Nationwide Children's Hospital, Grove City, OH, United States; Enas Alshaikh, Nationwide Children's Hospital, Pickerington, OH, United States; Sudarshan Jadcherla, Nationwide Children's Hospital, Columbus, OH, United States

Presenting Author(s)

Minna Njeh, BS, Chem (she/her/hers)

Research Assistant
Nationwide Children's Hospital
Columbus, Ohio, United States

Background: Gastroesophageal reflux (GER) disease (GERD) is a commonly assumed condition in infants with aero-digestive problems recovering in the neonatal ICU (NICU). Changes in feeding methods are highly prevalent and added rice formulas are commonly prescribed, albeit with unintended consequences. Additionally, mechanistic effects of added rice formulas on physical-, chemical-, spatial- and temporal characteristics of GER and symptoms remains unclear.

Objective: Therefore, our aims were to characterize and compare the direct effects of routine diet vs added rice formula on the characteristics of GER events, clearance mechanisms, and symptoms in convalescing NICU infants.

Design/Methods: Infants (N=40, 31 ± 5 weeks birth gestation) who were under consideration for GERD diagnosis, feeding modifications and/or pharmacological therapies were first evaluated at 43 ± 4 weeks postmenstrual age using 24-hour pH-impedance testing with symptom correlation. Each infant was fed with their routine diet for half of the feeds, and with added rice formula for the other half. Data analysis of the specified feeds was performed on postprandial sessions and included: acid reflux index, GER event frequency and type, clearance times for acid and bolus refluxate, distal baseline impedance (a surrogate marker of inflammation), and frequency of overall and individual symptoms. Pairwise comparisons were performed between routine diet and added rice formula for GER characteristics and symptoms in all infants.

Results: Comparison of pH-impedance and symptom characteristics is shown in Table 1. Significantly, added rice formula: 1) has no effect on the characteristics of acid-GER events, 2) decreases the frequency of liquid weakly acid events, mixed reflux events, and proximal reflux events, and 3) has no effect on the overall number of symptoms, but decreases the number of coughing episodes.

Conclusion(s):

Our pH-Impedance testing protocol identifies direct effects of therapies at the point of care. Added rice formula does not impact acid-specific GER characteristics or symptom generation but decreases the frequency and height of refluxate in infants. We speculate that the effect of added rice formula is modified by the severity of acid reflux index. In high-risk NICU infants with objective GERD diagnoses, clinical trials are needed to examine the short-term (safety, growth, and effectiveness) and long-term (growth and development) effects of feeding modifications such as added rice formula.