Small Volumes of Feed Can Trigger Transient Lower Esophageal Sphincter Relaxation and Gastroesophageal Reflux in the Right Lateral Position in Infants

Michiel P. van Wijk, Marc A. Benninga, Geoffrey P. Davidson, Ross Haslam, Taher I. Omari

Research output: Contribution to journalArticleAcademicpeer-review

33 Citations (Scopus)


Objective To investigate the threshold amount of constantly infused feed needed to trigger lower esophageal sphincter relaxation (TLESR) in the right lateral position (RLP) and left lateral position (LLP). Study design Eight healthy infants (3 male; gestational age: 32.9 +/- 2.4 weeks; corrected age: 36.1 +/- 1.3 weeks) were studied using an esophageal impedance-manometry catheter incorporating an intragastric infusion port. After tube placement, infants were randomly positioned in RLP or LLP. They were then tube-fed their normal feed (62.5 [40 to 75] mL) at an infusion rate of 160 mL/h. Recordings were made during the feed and 15 minutes thereafter. The study was repeated with the infant in the opposite position. Results More TLESRs were triggered in the RLP compared with LLP (4.0 [3.0 to 6.0] vs 2.5 [1.0 to 3.0], P = .027). First TLESR occurred at a significantly lower infused volume in RLP compared with LLP (10.6 +/- 9.4 vs 21.0 +/- 4.9 mL, P = .006). The percentage of feed infused at time of first TLESR was significantly lower in RLP compared with LLP (17.6% +/- 15.5% vs 35.4% +/- 8.02%, P = .005). Conclusions In the RLP, TLESRs and gastroesophageal reflux are triggered at volumes unlikely to induce gastric distension. (J Pediatr 2010; 156: 744-8)
Original languageEnglish
Pages (from-to)744-U91
JournalJournal of pediatrics
Issue number5
Publication statusPublished - May 2010


  • Electric Impedance
  • Enteral Nutrition
  • Esophageal Sphincter, Lower/physiopathology
  • Female
  • Gastroesophageal Reflux/physiopathology
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases/physiopathology
  • Male
  • Manometry
  • Muscle Relaxation
  • Posture

Cite this