Abstract
Background
In adults, distal baseline impedance (BI) is a determinant of esophageal mucosal integrity with values <900 Ω indicating inflammation. Relationships between acid gastroesophageal reflux (GER) and BI in neonates are unclear.
Methods
NICU infants (N = 198, 30.4 ± 0.3 weeks gestation) were evaluated at 43 ± 0.4 weeks postmenstrual age using 24-h pH-impedance. Ten randomly selected 1-min windows during rest from the distal impedance channel (Z6) were averaged. Chi-square, t-tests, and ANOVA were used to compare pH-impedance and symptom characteristics by BI severity (BI < 900 Ω, BI 900–2000 Ω, BI > 2000 Ω). Regression analysis was used to identify potential contributing factors of BI.
Results
In BI < 900 Ω: (1) pH-impedance characteristics were increased (acid reflux event frequency, duration, and severity, all P < 0.05 vs. BI > 2000 Ω), and (2) positive symptom correlations were noted with bolus (73%) and acid events (55%). Significant predictors of BI included chronological age, acid reflux index, and BPD diagnosis (all P < 0.05).
Conclusions
Low BI is associated with prolonged acid exposure, delayed clearance, and greater aerodigestive symptom prevalence, likely associated with inflammation and or increased mucosal permeability. BI > 2000 Ω likely involves little or no inflammation because acid exposure is minimal. Combination of SAP, pH-impedance metrics, and BI along with the clarification of dysmotility mechanisms provides the rationale for personalized anti-reflux therapies as needed.
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ACKNOWLEDGMENTS
We are grateful to Rebecca Moore, BSN RN, for helping with IRB coordination, demographic data extraction, and verification. The study was supported in part by RO1 NIH DK 068158.
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S.R.J. developed the concepts, study design, obtained grant funding and ethical approvals from IRB. S.N. and K.A.H. were also associated with analysis design. N.H. and K.A.H. acquired data and performed analysis. S.N. performed statistical analysis. N.H. created figures. S.R.J., N.H., K.A.H., and S.N. were all involved with data verification, interpretation of results, writing, editing, and approval of final manuscript.
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Jadcherla, S.R., Hanandeh, N., Hasenstab, K.A. et al. Differentiation of esophageal pH-impedance characteristics classified by the mucosal integrity marker in human neonates. Pediatr Res 85, 355–360 (2019). https://doi.org/10.1038/s41390-018-0237-z
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DOI: https://doi.org/10.1038/s41390-018-0237-z
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