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

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.