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To combine manometry and impedance to characterize the mechanisms of gastroesophageal reflux (GER) and to explore their relation to the rate of gastric emptying (GE) and body position.Ten healthy preterm infants (35 to 37 weeks' postmenstrual age) were studied with the use of a micromanometric/impedance assembly. Episodes of GER were identified by impedance, and the mechanism(s) of GER triggering and GER clearance were characterized. GE was determined with a C13Na-octanoate breath test.Gastroesophageal reflux episodes (n=89) were recorded, consisting of 74% liquid, 14% gas, and 12% mixed. Transient lower esophageal sphincter relaxation (TLESR) was the predominant mechanism of reflux, triggering 83% of GER. Of 92 TLESRs recorded, 27% were not associated with reflux. Infants studied in the right lateral position had significantly (P.01) more GER, a higher proportion of liquid GER (P.05), and faster GE (P.005) when compared with infants studied in the left lateral position.In healthy preterm infants, GER is predominantly liquid in nature. Right-side positioning is associated with increased triggering of TLESR and GER despite accelerating GE.

OBJECTIVE: To identify a body-positioning regimen that promotes gastric emptying (GE) and reduces gastroesophageal reflux (GER) by changing body position 1 hour after feeding.STUDY DESIGN: Ten healthy preterm infants (7 male; mean postmenstrual age, 36 weeks [range, 33 to 38 weeks]) were monitored with combined esophageal impedance-manometry. Infants were positioned in the left lateral position (LLP) or right lateral position (RLP) and then gavage-fed. After 1 hour, the position was changed to the opposite side. Subsequently, all infants were restudied with the order of positioning reversed.RESULTS: There was more liquid GER in the RLP than in the LLP (median, 9.5 [range, 6.0 to 22.0] vs 2.0 [range, 0.0 to 5.0] episodes/hour; P = .002). In the RLP-first protocol, the number of liquid GER episodes per hour decreased significantly after position change (first postprandial hour [RLP], 5.5 [2.0 to 13.0] vs second postprandial hour [LLP], 0.0 [0.0 to 1.0]; P = .002). GE was faster in the RLP-first protocol than in the LLP-first protocol (37.0 +/- 21.1 vs 61.2 +/- 24.8 minutes; P = .006).CONCLUSIONS: A strategy of right lateral positioning for the first postprandial hour with a position change to the left thereafter promotes GE and reduces liquid GER in the late postprandial period and may prove to be a simple therapeutic approach for infants with GER disease.