Early feeding resistance: A possible consequence of neonatal oro-oesophageal dyskinesia

Authors


Véronique Abadie, Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, FR-75015 Paris, France (Tel. +33 1 4449 5211, fax. +33 1 4438 1750, e-mail. veronique.abadie@nck.ap-hop-paris.fr)

Abstract

Paediatricians frequently find early feeding disorders in neonates and infants that result in poor weight gain and which sometimes have no clear organic basis. For many years, we have observed infants with unexplained poor feeding skills and excessive regurgitation, and since 1992 we have prospectively performed oesophageal manometry in infants hospitalized for retarded growth and “unexplained” feeding disorders. From the group of infants hospitalized for growth failure in the General Paediatric Unit of Necker-Enfants Malades Hospital from 1992 to 1997, we identified 16 children (3%) with abnormal feeding behaviour who had an abnormal oesophageal manometry. The manometric data of these children were compared with those of a group of 16 age-matched children who underwent oesophageal manometry for other reasons, and served as controls. The affected children had precocious feeding skills disorders: prolonged bottle-feeding (75%), bottle refusal (75%), unexplained crying (63%) and excessive regurgitation (94%). Half of them had mild anatomical facial consequences of their poor foetal sucking, and mild pharyngolaryngeal hypotonia, which could not be considered as malformations. Apart from these disorders, their clinical status was normal. At inclusion, their oesophageal manometry was abnormal, showing in 70% of cases specific anomalies: lower oesophageal sphincter hypertonia and/or partial failure to relax, and giant waves of oesophagus body. Their course was good and their feeding difficulties decreased around the end of the first year, with the acquisition of normal voluntary mastication.

Conclusion: We suggest that the early feeding resistance of this group of children could be | related to an organic and transient neonatal oro-oesophageal dyskinesia.

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