Effect Of Body Position Intervention On Postprandial Gastroesophageal Reflux And Gastrointestinal Function In Premature Infants

Gastroesophageal reflux (GER) is quite common during infancy,especially in preterm infants. The increased risk of GER in preterminfants is thought to be due to immature or impaired anatomic andphysiologic factors that stomach in a horizontal position, with a smallcapacity, immature pyloric sphincter, poor intestinal nerve regulatingfunction. Mild GER occurs in80%~85%of preterm infant. GER cancause more severe symptoms, such as feeding problems and failure tothrive, and such complications as esophagitis，anemia，malnutrition，aspiration pneumonia, apnea or lead to death. Pharmacologicalovertreatment is unuseful and potentially harmful. Recent years,neonatologist promote nonpharmacological interventions such as bodypositioning, modifications in feeding modalities, or milk thickening,should be considered the most advisable choice to manage GER inpreterm infants. Of them, body positioning can be considered the mostestablished and safe treatment. Some research show that there was moreliquid GER in the right lateral position (RLP) than in the left lateralposition (LLP); Gastric emptying (GE) was faster in the RLP than theLLP. There was no a position can both decrease GER and not affect GE or gastrointestinal function. This is the common concern of theperinatology and neonatology. In order to overcome such problems, weresearch the effect of three different positions on postprandial GER andgastrointestinal function.Objective：To explore the effect of supine position, LLP position, changed lateralposition(infants were positioned in the LLP, after1hour, the position waschanged to the RLP, after1hour,position was changed to the LLP), so asto provide proofs on GER reducing and facilitate gastrointestinalfunction.Methods:90prematures who were hospitalized in the Neonatology Departmentof the second Hospital of Jilin University from October,2013to February,2014were selected according to some matching conditions and weredivided randomly into three groups with the same cases. The groupsincluded supine position group, LLP group and changed lateral positiongroup (infants were positioned in the LLP, after1hour, the position waschanged to the RLP, after1hour, position was changed to the LLP).Observation target include number of vomit, incidence rate of apnea,incidence rate of aspiration pneumonia, gastric residual rate, and Weightincreasing. SPSS19.0software was applied to statistical data analysis, andp<0.05was defined as a statistically significant difference. Results：(1) In terms of gender, gestational age, birth weight and the time tobegin feeding, p>0.05, so the difference is not statistically significant.(2) Results show that LLP group and changed lateral position groupare less than supine position group in terms of incidence rate of apnea andincidence rate of aspiration pneumonia，p＜0.0167, so it is statisticallysignificant. When LLP group compare with changed lateral positiongroup, p>0.0167, the difference is not statistically significant; LLP groupand changed lateral position group are less than supine position group interms of number of vomiting，p＜0.05, so it is statistically significant.When LLP group compare with changed lateral position group, p>0.05,the difference is not statistically significant;(3) When compared changed lateral position group with the other twogroups in terms of gastric residual percentage, changed lateral positiongroup smaller than the other group, p＜0.0167, the difference of them isstatistically significant. When compared supine position group with LLPgroup in terms of gastric residual percentage, LLP group bigger thansupine position group, p＜0.0167, the difference of them is statisticallysignificant.(4) In terms of weight increasing after two weeks, changed lateralposition group more than the other groups, p＜0.001, the difference ofthem is statistically significant. When compared supine position group with LLP group, p>0.05, the difference is not statistically significant.Conclusions:(1) Both changed lateral position and LLP can reduce thecomplications of GER. The effect of them is same.(2) LLP can reduce the complications of GER, but it was notfacilitate to gastric emptying. So LLP was not facilitated togastrointestinal function and hindered weight increasing.(3) Changed lateral position both can reduce the complications ofGER and can also accelerate gastric emptying. So changed lateralposition was facilitate to weight increasing.