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Study Reveals New Use for GER Tool in Neonates: Swallowing Analysis

Study Reveals New Use for GER Tool in Neonates: Swallowing Analysis 1024 683 Katie Brind'Amour, PhD, MS, CHES
Dr. Jadcherla

Investigators have repurposed a simple test for gastroesophageal reflux (GER) disease to provide valuable insight into multiple swallowing abnormalities in newborn babies.

A tool used to diagnose gastroesophageal reflux disease (GERD) in hospitalized neonates now has another use: characterizing swallowing abilities. The researchers at Nationwide Children’s Hospital who pioneered the objective use of the test, called pH-impedance testing, for GERD diagnosis recently published their characterization of swallowing patterns during feeding sessions in both fully oral-fed and partially oral-fed infants in The Journal of Pediatrics.

By utilizing this test to identify normal and abnormal feeding and swallowing patterns in these infants, the team has expanded the tool’s clinical utility without adding to testing burden for these tiny patients.

pH-impedance testing involves insertion of a tiny probe through the nose and down the esophagus to measure the pH and the presence of liquids, solids and gases by impedance values throughout the esophagus. For the past couple of decades, leading neonatal centers have used it in newborns for evaluation of GERD. Its use in neonates has been concentrated in about a dozen highly skilled facilities worldwide, but the relative simplicity and increasing objectivity of this automated analysis for GERD testing could now facilitate broader adoption.

“In my mind, the use of impedance in the analysis of swallowing is novel. Why this is groundbreaking is that this particular methodology does not require a lot of training or sophistication to analyze. However, analysis of swallowing manually can be tedious,” says Sudarshan Jadcherla, MD, principal investigator at the Center for Perinatal Research at the Abigail Wexner Research Institute and the medical director of the Neonatal and Infant Feeding Disorders Program at Nationwide Children’s.

“Once trained in general pH-impedance techniques,” Dr. Jadcherla says, “any program can use this paper’s information to screen if a baby has central swallowing problems when they’re already screening for GERD.”

The team examined swallows, acid reflux and feeding session characteristics over the course of 24 hours in 40 infants, half of whom were fully orally feeding and the other half of whom had only partial oral feedings. While GER was more common in the fully orally fed babies, they were able to consume more during feedings and had shorter hospital stays — despite comorbidities — than their counterparts fed only partially by mouth.

“Eating is a skill, and skill development happens only with practice, so partially oral-fed babies are only getting partial experience and development,” says Dr. Jadcherla, explaining a likely factor behind these findings. “But why are feeding difficulties happening in some babies and not others? It may be immaturity, neuropathology, breathing disturbance, GER or a combination of issues — for any given baby, we don’t know yet which factors contribute what proportion to their problems.”

The study summarizes characteristics of more than 10,600 swallows, as well as observed trends over the course of feeding sessions, allowing pH-impedance testing to now help identify the existence of possible neurological or physical causes for feeding difficulties due to their different patterns in the test results. In turn, Dr. Jadcherla says, this can enable clinicians to improve their diagnostic considerations, point-of-care treatment decisions and referrals to tertiary care for advanced swallowing analysis, when needed.

“If we find some clues to central or peripheral swallowing abnormalities using pH-impedance testing, those babies will require some kind of evidence-based intervention,” says Dr. Jadcherla. “We would then offer high-resolution impedance manometry, where we meticulously evaluate the sensory and motor mechanisms of reflexes at different regions, whether oral, pharyngeal, upper esophageal and so on, and come up with strategies to reverse the abnormality.”

Once they pinpoint the underlying problem, appropriate therapy can improve feeding skills, helping babies gain weight and simplifying their care after discharge.

Dr. Jadcherla’s team plans to expand their efforts to include the new swallowing analysis for any patients undergoing pH-impedance testing in the entire Nationwide Children’s NICU network. His team also leads the GERD Infants in Feeding and Therapeutics (GIFT) Trial at Nationwide Children’s, which compares the effects of natural maturation vs thickened formula or acid suppression for gastroesophageal reflux disease (GERD). In addition, an ongoing clinical trial evaluating the mechanisms of oral swallowing and sucking reflexes across maturation is in progress.

“This publication shows that you can look for multiple conditions with one approach, so this tool is very valuable,” says Dr. Jadcherla, who has trained clinicians at several of the world’s other current pH-impedance testing centers for neonates. “If we can train more centers to use pH-impedance testing, we will be in the position to conduct multicenter clinical trials that can get more answers for critical questions regarding care for babies with feeding difficulties.”

 

Reference:

Alexander A, Helmick R, Plumb T, Alshaikh E, Jadcherla SR. Characterizing Biomarkers of Continuous Peristalsis and Bolus Transit During Oral Feeding in Infants at pH-Impedance Evaluation: Clinical and Research Implications. Journal of Pediatrics. 2024 Jun 17;274:114154.

Image credit: Nationwide Children’s

 

 

About the author

Katherine (Katie) Brind’Amour is a freelance medical and health science writer based in Pennsylvania. She has written about nearly every therapeutic area for patients, doctors and the general public. Dr. Brind’Amour specializes in health literacy and patient education. She completed her BS and MS degrees in Biology at Arizona State University and her PhD in Health Services Management and Policy at The Ohio State University. She is a Certified Health Education Specialist and is interested in health promotion via health programs and the communication of medical information.

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