Transpyloric Feedings -A Reassessment

A recent commentary (MH Wallenstein, DK Stevenson. JAMA Pediatr. 2018;172(11):1004-1005.) discusses the potential advantages of transpyloric feedings in premature infants. Thanks to Ben Gold for this reference.

Key points:

  • First, preterm infants are highly susceptible to pulmonary aspiration, primarily due to, among other factors, immature tone of the lower esophageal sphincter and use of uncuffed endotracheal tubes.”
  • Second, aspiration of gastric contents probably contributes to bronchopulmonary dysplasia..
  • Third, transpyloric feeding is an effective strategy to reduce the risk of aspiration…we believe that early prophylactic transpyloric feeding may be the only effective strategy to prevent aspiration-associated lung injury.
  • Transpyloric feedings “fell out of favor in the 1980s after a single trial showed an increased risk of mortality”

My take (borrowed from authors): “the practice of early transpyloric feeding with human breastmilk merits a thorough reevaluation of its risks and benefits in the setting of modern neonatal practice.”

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