1667 DETECTION OF GASTRIC CONTENTS IN TRACHEAL FLUID OF PRETERM INFANTS

Abstract

Aspiration of feedings in critically ill preterm infants requiring mechanical ventilation may prolong their ventilatory course and may contribute to the development of chronic lung disease. While massive aspiration can be diagnosed radiographically, we became concerned with the problem of identifying recurrent subclinical aspiration. A more sensitive method of detection utilizes an in vitro lactase assay to measure the presence of lactose (breast milk has approx. 0.2M lactose) in the tracheal aspirates of these infants. In this assay each mole of lactose is hydrolyzed to an equimolar amount of glucose. In order to establish a baseline glucose range, we measured the tracheal glucose level from 17 preterm infants (G.A. 26-37 wks; B. wt. 670-2950 gm) during the 1st wk of life while the infants were intubated. A total of 52 samples were collected (36 samples from gavage fed/16 infants not fed). The mean tracheal glucose level was 2.67±2.77 mg/dl (15.05±15.23 umole/dl). The range was 0.02-11.57 mg/dl (.08-64.22 umole/dl). The glucose level did not vary with gestational age, birth weight, postnatal age or feeding. We then obtained tracheal aspirates from 5 infants on ventilators who received breast milk by gavage. In 2 infants, lactose levels were 112 mg/dl (327 umole/dl) and 21.9 mg/dl (64.1 umoles/dl) respectively. Lactose was not detected in the other 3 infants. These preliminary findings suggest that the lactase assay may provide a sensitive method for detecting aspiration of gastric contents in ventilator dependent infants.

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