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Gastroesophageal reflux during postpyloric versus gastric tube feeding in preterm infants with bronchopulmonary dysplasia

Journal of Perinatology volume 45, pages 1781–1787 (2025)Cite this article

Subjects

Abstract

Background

Whether postpyloric feeding reduces gastroesophageal reflux (GER) in very preterm infants with bronchopulmonary dysplasia (BPD) is uncertain.

Methods

Prospective observational study comparing GER profiles measured using 24-h esophageal pH-impedance monitoring in infants with BPD receiving clinically prescribed postpyloric (n = 21) or gastric (n = 24) tube feeding.

Results

Participants (median gestational age 25.0 weeks, IQR 24.1–26.9) underwent testing at a median postmenstrual age of 46.6 weeks (IQR 42.7–52.4). The number of GER episodes recorded by impedance varied widely (median 27, range 1–195). Postpyloric versus gastric feeding was associated with fewer GER episodes (median, IQR: 16, 5–41 vs. 40, 19–60; p = 0.07) and less exposure of the proximal esophagus to reflux (median duration, IQR: 0.1 min, 0.005–0.6 vs. 0.77 min, 0.16–1.8; p = 0.045), but a higher proportion of acidic (pH < 4) GER episodes (median, IQR: 91%, 70–100 vs. 31%, 16-54; p < 0.001).

Conclusion

Postpyloric feeding may reduce total GER burden but increase the relative proportion of acidic GER in infants with BPD.

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Fig. 1: Reflux profiles for individual study participants.
Fig. 2: Number of reflux episodes on impedance monitoring stratified by route and rate of feed administration.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Erik Jensen received grant support from the National Heart Lung and Blood Institute (K23HL136843 and R01HL168066).

Author information

Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Erik A. Jensen, Carolyn M. Orians & Kathleen Gibbs

  2. Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Matthew Ryan

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  1. Erik A. Jensen
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Contributions

Jensen conceptualized and designed the study, obtained funding, participated in data acquisition, analyzed and interpreted the data, drafted the initial and final manuscript, and approved the final version for publication. Orians helped conceptualize and design the study, collected and interpreted the data, critically revised the manuscript for important intellectual content, and approved the final version for publication. Gibbs helped conceptualize and design the study, interpreted the data, critically revised the manuscript for important intellectual content, and approved the final version for publication. Ryan helped conceptualize and design the study, performed masked review of all pH-impedance studies, helped interpret the study data, critically revised the manuscript for important intellectual content, and approved the final version for publication. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Erik A. Jensen.

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Competing interests

The authors declare no competing of interests.

Ethics approval and consent to participate

The study protocol, including all described study data collections and diagnostic procedures, were approved by the Institutional Review Board at the Children’s Hospital of Philadelphia (IRB Study Number – 19-016537) and were performed in adherence with all relevant guidelines and regulations. Informed, written parental consent was obtained for each study participant prior to initiating study procedures.

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Jensen, E.A., Orians, C.M., Gibbs, K. et al. Gastroesophageal reflux during postpyloric versus gastric tube feeding in preterm infants with bronchopulmonary dysplasia. J Perinatol 45, 1781–1787 (2025). https://doi.org/10.1038/s41372-025-02301-5

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