There are a multitude of gastrointestinal problems that develop in infants who have hypoxic-ischemic encephalopathy (HIE).  One of the most pressing needs is determining how best to feed these infants.  A recent study provides more information on the aberrant esophageal function of these infants (J Pediatr 2013; 162: 976-82).

Design:  provocative esophageal manometry was performed in 34 neonates (27 with HIE and 7 controls).  HIE inclusion criteria included the following:

1. >36 weeks gestational age
2. acute perinatal event: abruption, cord prolapse, severe fetal heart rate abnormality
3. signs of encephalopathy per Sarnat staging at birth

The characteristics of the HIE neonates is further defined and divided into those who were treated with hypothermia and those who received traditional care.  All but one infant had an abnormal brain MRI.

Key results:

• Peristaltic reflexes, upper esophageal sphincter contractile responses (much greater in HIE patients), lower esophageal sphincter relaxation responses (much lower in HIE patients) and esophageal body coordination and clearance were all noted to be abnormal.
• Infants treated with hypothermia had greater upper esophageal sphincter contractile responses and improved esophageal clearance (noted by decreased peristaltic durations).

Overall, this study demonstrates prolonged and poorly coordinated peristaltic responses in neonates with HIE.  There are no effective treatments for this type of esophageal dysmotility.  As such, even with current management approaches including gastroesophageal reflux medications and fundoplication, children with HIE remain at risk for aerodigestive malfunction and aspiration.

Related blog links:

• Fundoplication effects on esophageal motility | gutsandgrowth
• The Medical Pendulum and Gastroesophageal Reflux | gutsandgrowth