Effect of Positioning on Tracheal Aspirate Pepsin Levels as Marker of Aspiration of Gastric Contents in Ventilated Preterm Neonates

Abstract

SUMMARY G ER is extremely common in preterm infants due to immature or impaired anatomic and physiologic factors that typically limit reflux. Premature infants are predisposed to GER and are at increased risk for pulmonary aspiration. Several factors that lead to aspiration of gastric contents in premature neonates are intubations and mechanical ventilation, use of sedation, immature swallowing mechanism, reduced muscle tone and suppression of reflexes that protect the airways. When preterm infant have been given (IPPV) for respiratory failure a significant contributing factor thought to delay weaning from MV, and developing BPD. The aim of our study was to evaluate the effect of positioning on tracheal aspirate pepsin levels as a marker of aspiration of gastric content in preterm ventilated neonates. Our study included 60 preterm neonates <37wk, they were then divided into 2 groups, each group composed of 30 neonates. Then we introduce entral feds/ 3hours on mechanical ventilation, Group 1 was allowed to lie 6 hours on right lateral position while Group 2 was allowed to lie 6 hours on supine position during which tracheal aspirate samples was taken at end of the 6 hours Both groups were subjected to history taking, clinical examination and investigations included: Chest x-ray, Initial labs: (CBC, CRP, Blood culture), Follow up labs in deterioration of the condition: (CBC, CRP), Tracheal aspirate samples collection and pepsin analysis. Both groups were comparable as regards age at the time of the procedure, sex, GA, BW, mode of delivery and enteral fed volume during the procedure and there were no significant difference between the two the groups. Also, there were no statistically difference regarding mode of mechanical ventilation, different ventilator settings and duration of ventilation between the two studied groups. As regard BPD fate, the difference between the two studied groups was minimal (43.3% vs 50%) p=0.6 this is due to multiple factors were implicated in the pathogenesis of BPD including high oxygen, ventilator-induced lung injury, symptomatic PDA, and nutritional deficiencies. Also the mortality rate and cause of death in our study were not statistically significant between the two studied groups.