Effect of cereal-thickened formula and upright positioning on regurgitation, gastric emptying, and weight gain in infants with regurgitation

Objective We compared the effect of cereal-thickened formula or postural therapy on regurgitation and gastroesophageal reflux, weight gain, and gastric emptying in infants. Methods We performed a prospective trial in exclusively formula-fed infants 2 to 6 mo of age presenting with regurgitation or vomiting at least three times a day. Infants were randomized into two groups; group A received cereal-thickened formula versus group B who were placed in a postprandial upright position for 90 min and evaluated over an 8-wk period. A 90-min technetium 99m milk scintigraphy was performed before and at the end of the intervention period. Results Thirty-one infants were included in group A and 32 in group B; at inclusion, there were no anthropometric differences between groups (P = 0.813–0.955). After 4 and 8 wk, the difference in regurgitation frequency per day between groups A and B had become significant (at 4 wk, 2.39 ± 0.86 for group A versus 2.84 ± 0.81 for group B, P = 0.039; at 8 wk, 1.61 ± 0.76 for group A versus 2.38 ± 0.83 for group B, P < 0.001). The volume ingested per meal was not different between groups after 4 wk, although this parameter showed a larger intake in group A after 8 wk (156.8 ± 23.5 mL for group A versus 143.4 ± 25.1 mL for group B, P = 0.035), resulting in a significant difference in mean caloric intake. Gastric emptying after 8 wk showed no significant difference between groups A and B. Group A infants had significantly greater weight gain than did group B infants after 4 wk (636.2 ± 103.4 g for group A versus 577.4 ± 102.7 g for group B, P = 0.03) and 8 wk (1261.3 ± 131.4 g for group A versus 1121.4 ± 137.2 g for group B, P < 0.001). After 8 wk of intervention, the increase in length was significantly greater in group A than in group B (5.2 ± 0.6 cm for group A versus 4.7 ± 0.6 cm for group B, P = 0.032). Conclusion Cereal-thickened formula is significantly more efficacious than postural therapy in decreasing the frequency of regurgitation in regurgitating infants. Treatment of regurgitation with cereal-thickened formula results in an increased caloric intake (not, vert, similar25%), related to increased gain in weight and length, in comparison with regular formula and positioning therapy.