Effect of Body Position Changes on Postprandial Gastroesophageal Reflux and Gastric Emptying in the Healthy Premature Neonate

Objective

To identify a body-positioning regimen that promotes gastric emptying (GE) and reduces gastroesophageal reflux (GER) by changing body position 1 hour after feeding.

Study design

Ten healthy preterm infants (7 male; mean postmenstrual age, 36 weeks [range, 33 to 38 weeks]) were monitored with combined esophageal impedance-manometry. Infants were positioned in the left lateral position (LLP) or right lateral position (RLP) and then gavage-fed. After 1 hour, the position was changed to the opposite side. Subsequently, all infants were restudied with the order of positioning reversed.

Results

There was more liquid GER in the RLP than in the LLP (median, 9.5 [range, 6.0 to 22.0] vs 2.0 [range, 0.0 to 5.0] episodes/hour; P = .002). In the RLP-first protocol, the number of liquid GER episodes per hour decreased significantly after position change (first postprandial hour [RLP], 5.5 [2.0 to 13.0] vs second postprandial hour [LLP], 0.0 [0.0 to 1.0]; P = .002). GE was faster in the RLP-first protocol than in the LLP-first protocol (37.0 ± 21.1 vs 61.2 ± 24.8 minutes; P = .006).

Conclusions

A strategy of right lateral positioning for the first postprandial hour with a position change to the left thereafter promotes GE and reduces liquid GER in the late postprandial period and may prove to be a simple therapeutic approach for infants with GER disease.

Abbreviations: EGJ, Esophagogastric junction, GE, Gastric emptying, GER, Gastroesophageal reflux, GERD, Gastroesophageal reflux disease, GEt_1/2, Gastric half-emptying time, LES, Lower esophageal sphincter, LLP, Left lateral position, PPH, Postprandial hour, RLP, Right lateral position, TLESR, Transient lower esophageal sphincter relaxation