Pilot Study of Pharyngoesophageal Dysmotility Mechanisms in Dysphagic Infants of Diabetic Mothers.

OBJECTIVE: Swallowing difficulties are common in infants of diabetic mothers (IDM) and mechanisms are unclear. We tested the hypothesis that pharyngoesophageal motility reflexes are distinct in IDMs compared with healthy controls in a pilot study. STUDY DESIGN: Basal and adaptive pharyngoesophageal motility characteristics of 20 dysphagic IDMs and 10 controls were studied using purpose-built micromanometry system. RESULTS: During basal swallows, IDMs had lower frequency of deglutition apneas (62.5 vs. 95.4%) and longer active upper esophageal sphincter (UES) relaxation duration (0.8 ± 0.1 vs. 0.4 ± 0.1 second), whereas during adaptive swallows, IDMs had longer response latency to esophageal peristalsis onset (24.4 ± 2.1 vs. 9.7 ± 2.9 seconds) and longer lower esophageal sphincter nadir duration (28.9 ± 3.2 vs. 12.9 ± 4.6) (all p < 0.05) compared with controls. Nine in the IDM group needed gastrostomy feeding tube at hospital discharge versus none in controls. CONCLUSION: Feeding difficulties in IDMs are likely to be associated with maladapted or maldeveloped vagal neuropathy mechanisms manifesting as dysregulation of pharyngeal-airway interactions, longer active UES relaxation response, delays in the activation of esophageal contractile apparatus during peristalsis, and prolonged inhibition at the gastroesophageal junction.

Stopping Parenteral Nutrition for 3 Hours Reduces False Positives in Newborn Screening.

OBJECTIVE: To evaluate effects of holding parenteral nutrition (PN) for 3 hours prior to newborn screening (NBS) on false-positive NBS rate for amino acids (AAs) in very low birth weight (VLBW) infants (birth weight <1500 g). STUDY DESIGN: We analyzed data from 12 567 consecutive births in 1 hospital between May 2010 and June 2013. VLBW infants were stratified into 3 groups: (1) infants without PN before NBS (no-PN group); (2) infants with early PN running at the time of NBS (early-PN group); and (3) infants with early-PN that were temporarily replaced by dextrose-containing intravenous fluid 3 hours prior to NBS (stop-PN group). We compared the false-positive rate for AA and cost effectiveness between the groups. RESULTS: The false-positive rate for AA among 413 VLBW infants was significantly higher than infants with birth weight >1500 g (7.62% vs 0.05%; P < .001). There were no false-positive results for AA in the no-PN group. The false-positive rate for AA in the stop-PN group (2/65) was significantly lower than the early-PN group (29/245) (3.1% vs 11.8%; P = .037). The stop-PN group was more cost effective than early-PN group, saving $17.27 per infant screened ($5.53 vs $22.80) or $192.54 for each false-positive result for AA averted. Further reductions in inconclusive samples were also noted. CONCLUSIONS: VLBW and early-PN are significant factors for false-positive results for AA. Holding PN containing AAs for 3 hours before NBS collection is a practical and cost-effective method to significantly reduce the false-positive rate for AA in VLBW infants.