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Differentiating esophageal sensitivity phenotypes using pH–impedance in intensive care unit infants referred for gastroesophageal reflux symptoms
Background To identify esophageal sensitivity phenotypes relative to acid (S Acid ), bolus (S Bolus ), acid and bolus (S Acid+Bolus ), and none (S None ) exposures in infants suspected with gastroesophageal reflux disease (GERD). Methods Symptomatic infants ( N = 279) were evaluated for GERD at 42...
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| Published in: | Pediatric research 2021-02, Vol.89 (3), p.636-644 |
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| creator | Jadcherla, Sudarshan R. Sultana, Zakia Hasenstab-Kenney, Kathryn A. Prabhakar, Varsha Gulati, Ish K. Di Lorenzo, Carlo |
| description | Background
To identify esophageal sensitivity phenotypes relative to acid (S
Acid
), bolus (S
Bolus
), acid and bolus (S
Acid+Bolus
), and none (S
None
) exposures in infants suspected with gastroesophageal reflux disease (GERD).
Methods
Symptomatic infants (
N
= 279) were evaluated for GERD at 42 (40–45) weeks postmenstrual age using 24-h pH–impedance. Symptom-associated probability (SAP) for acid and bolus components defined esophageal sensitivity: (1) S
Acid
as SAP ≥ 95% for acid (pH |
| doi_str_mv | 10.1038/s41390-020-0930-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7644596</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2399838639</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-dab64c4e3684b943d8f18b97fac3c8266893a4c52ea168e749f57df277e6a7663</originalsourceid><addsrcrecordid>eNp1kc9u1DAQxiMEokvhAbggS1y4BOzY8Z8LEiqFIlXiAmfL60yyrhI72M6qe-Md-oY8SR1tKQUJyZYtz2--Gc9XVS8Jfkswle8SI1ThGjdlK4pr_qjakLZcMGPicbXBmJKaKiVPqmcpXWFMWCvZ0-qENlS0hDeb6uaj63uI4LMz2fkBQQrzzgxgRpTAJ5fd3uUDmnfgQz7MkNCSVm6--PXzxk0zdMZbQM6XldeEPSBrIqDFu1zeeuNzQhFKkQgd6kNEg0k5hgeFSnRcrlE6THMOU3pePenNmODF3Xlaff90_u3sor78-vnL2YfL2jKBc92ZLWeWAeWSbRWjneyJ3CrRG0utbDiXihpm2wYM4RIEU30rur4RArgRnNPT6v1Rd162E3S2DCGaUc_RTSYedDBO_x3xbqeHsNeCM9aqVeDNnUAMPxZIWU8uWRhH4yEsSTfr7KnkVBX09T_oVViiL9_TTYspZkLxlSJHysaQUhnLfTME69VyfbRcF8v1arlem3j18Bf3Gb89LkBzBFIJ-QHin9L_V70FTxG9LA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2503047969</pqid></control><display><type>article</type><title>Differentiating esophageal sensitivity phenotypes using pH–impedance in intensive care unit infants referred for gastroesophageal reflux symptoms</title><source>Springer Nature</source><creator>Jadcherla, Sudarshan R. ; Sultana, Zakia ; Hasenstab-Kenney, Kathryn A. ; Prabhakar, Varsha ; Gulati, Ish K. ; Di Lorenzo, Carlo</creator><creatorcontrib>Jadcherla, Sudarshan R. ; Sultana, Zakia ; Hasenstab-Kenney, Kathryn A. ; Prabhakar, Varsha ; Gulati, Ish K. ; Di Lorenzo, Carlo</creatorcontrib><description><![CDATA[Background
To identify esophageal sensitivity phenotypes relative to acid (S
Acid
), bolus (S
Bolus
), acid and bolus (S
Acid+Bolus
), and none (S
None
) exposures in infants suspected with gastroesophageal reflux disease (GERD).
Methods
Symptomatic infants (
N
= 279) were evaluated for GERD at 42 (40–45) weeks postmenstrual age using 24-h pH–impedance. Symptom-associated probability (SAP) for acid and bolus components defined esophageal sensitivity: (1) S
Acid
as SAP ≥ 95% for acid (pH < 4), (2) S
Bolus
as SAP ≥ 95% for bolus, (3) S
Acid+Bolus
as SAP ≥ 95% for acid and bolus, or (4) S
None
as SAP < 95% for acid and bolus.
Results
Esophageal sensitivity prevalence (S
Acid
, S
Bolus
, S
Acid+Bolus
, S
None
) was 28 (10%), 94 (34%), 65 (23%), and 92 (33%), respectively. Emesis occurred more in S
Bolus
and S
Acid+Bolus
vs S
None
(
p
< 0.05). Magnitude (#/day) of cough and emesis events increased with S
Bolus
and S
Acid+Bolus
vs S
None
(
p
< 0.05). S
Acid+Bolus
had increased acid exposure vs S
None
(
p
< 0.05). Distributions of feeding and breathing methods were distinct in infants with S
Bolus
vs S
None
(both,
p
< 0.05). Multivariate analysis revealed that arching and irritability events/day were lesser at higher PMAs (
p
< 0.001) and greater for infants on NCPAP (
p
< 0.01) with S
Bolus
and S
Acid+Bolus
(
p
< 0.05). Coughs/day was greater at higher PMAs (
p
< 0.001) for infants with gavage and transitional feeding methods (
p
< 0.02) with S
Bolus
and S
Acid+Bolus
(
p
< 0.05) but lesser with Trach (
p
< 0.001). Number of emesis events/day were greater with S
Bolus
and S
Acid+Bolus
(
p
< 0.001). Sneezes/day decreased for infants on Trach (
p
= 0.02).
Conclusions
Feeding and breathing methods can influence the frequency and type of aerodigestive symptoms. We differentiated esophageal sensitivity phenotypes in NICU infants referred for GERD symptoms using pH–impedance. Acid sensitivity alone was rare, which may explain poor response to acid suppressives; aerodigestive symptoms were predominantly linked with bolus spread. Magnitude of esophageal acid exposure and esophageal sensitivity to bolus spread may explain the pathophysiological basis for symptoms.
Impact
Objective GERD diagnosis and reasons for symptoms in NICU infants remains unclear.
Differentiation of esophageal sensitivities by acid and bolus components of GER reveal distinct symptom profiles, specifically the bolus component of GER significantly contributes to symptom occurrence.
Acid only sensitivity to GER is rare, and acid-suppressive therapy alone may not improve symptoms in a majority of NICU infants.
Magnitude of esophageal acid exposure and esophageal sensitivity to any bolus spread may explain the pathophysiological basis for symptoms. Feeding and breathing methods can influence the frequency and type of aerodigestive symptoms.
GERD treatments should be individualized to the patient’s GERD phenotype and likely also target the bolus component of GER.]]></description><identifier>ISSN: 0031-3998</identifier><identifier>EISSN: 1530-0447</identifier><identifier>DOI: 10.1038/s41390-020-0930-6</identifier><identifier>PMID: 32375162</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Acids ; Clinical Research Article ; Cough ; Critical Care ; Electric Impedance ; Enteral Nutrition ; Esophagus ; Esophagus - metabolism ; Esophagus - pathology ; Female ; Gastroesophageal reflux ; Gastroesophageal Reflux - pathology ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Premature - physiology ; Intensive Care Units ; Intensive Care Units, Neonatal ; Male ; Medicine ; Medicine & Public Health ; Multivariate Analysis ; Pediatric Surgery ; Pediatrics ; Phenotype ; Probability ; Sensitivity and Specificity</subject><ispartof>Pediatric research, 2021-02, Vol.89 (3), p.636-644</ispartof><rights>International Pediatric Research Foundation, Inc 2020</rights><rights>International Pediatric Research Foundation, Inc 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-dab64c4e3684b943d8f18b97fac3c8266893a4c52ea168e749f57df277e6a7663</citedby><cites>FETCH-LOGICAL-c470t-dab64c4e3684b943d8f18b97fac3c8266893a4c52ea168e749f57df277e6a7663</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32375162$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jadcherla, Sudarshan R.</creatorcontrib><creatorcontrib>Sultana, Zakia</creatorcontrib><creatorcontrib>Hasenstab-Kenney, Kathryn A.</creatorcontrib><creatorcontrib>Prabhakar, Varsha</creatorcontrib><creatorcontrib>Gulati, Ish K.</creatorcontrib><creatorcontrib>Di Lorenzo, Carlo</creatorcontrib><title>Differentiating esophageal sensitivity phenotypes using pH–impedance in intensive care unit infants referred for gastroesophageal reflux symptoms</title><title>Pediatric research</title><addtitle>Pediatr Res</addtitle><addtitle>Pediatr Res</addtitle><description><![CDATA[Background
To identify esophageal sensitivity phenotypes relative to acid (S
Acid
), bolus (S
Bolus
), acid and bolus (S
Acid+Bolus
), and none (S
None
) exposures in infants suspected with gastroesophageal reflux disease (GERD).
Methods
Symptomatic infants (
N
= 279) were evaluated for GERD at 42 (40–45) weeks postmenstrual age using 24-h pH–impedance. Symptom-associated probability (SAP) for acid and bolus components defined esophageal sensitivity: (1) S
Acid
as SAP ≥ 95% for acid (pH < 4), (2) S
Bolus
as SAP ≥ 95% for bolus, (3) S
Acid+Bolus
as SAP ≥ 95% for acid and bolus, or (4) S
None
as SAP < 95% for acid and bolus.
Results
Esophageal sensitivity prevalence (S
Acid
, S
Bolus
, S
Acid+Bolus
, S
None
) was 28 (10%), 94 (34%), 65 (23%), and 92 (33%), respectively. Emesis occurred more in S
Bolus
and S
Acid+Bolus
vs S
None
(
p
< 0.05). Magnitude (#/day) of cough and emesis events increased with S
Bolus
and S
Acid+Bolus
vs S
None
(
p
< 0.05). S
Acid+Bolus
had increased acid exposure vs S
None
(
p
< 0.05). Distributions of feeding and breathing methods were distinct in infants with S
Bolus
vs S
None
(both,
p
< 0.05). Multivariate analysis revealed that arching and irritability events/day were lesser at higher PMAs (
p
< 0.001) and greater for infants on NCPAP (
p
< 0.01) with S
Bolus
and S
Acid+Bolus
(
p
< 0.05). Coughs/day was greater at higher PMAs (
p
< 0.001) for infants with gavage and transitional feeding methods (
p
< 0.02) with S
Bolus
and S
Acid+Bolus
(
p
< 0.05) but lesser with Trach (
p
< 0.001). Number of emesis events/day were greater with S
Bolus
and S
Acid+Bolus
(
p
< 0.001). Sneezes/day decreased for infants on Trach (
p
= 0.02).
Conclusions
Feeding and breathing methods can influence the frequency and type of aerodigestive symptoms. We differentiated esophageal sensitivity phenotypes in NICU infants referred for GERD symptoms using pH–impedance. Acid sensitivity alone was rare, which may explain poor response to acid suppressives; aerodigestive symptoms were predominantly linked with bolus spread. Magnitude of esophageal acid exposure and esophageal sensitivity to bolus spread may explain the pathophysiological basis for symptoms.
Impact
Objective GERD diagnosis and reasons for symptoms in NICU infants remains unclear.
Differentiation of esophageal sensitivities by acid and bolus components of GER reveal distinct symptom profiles, specifically the bolus component of GER significantly contributes to symptom occurrence.
Acid only sensitivity to GER is rare, and acid-suppressive therapy alone may not improve symptoms in a majority of NICU infants.
Magnitude of esophageal acid exposure and esophageal sensitivity to any bolus spread may explain the pathophysiological basis for symptoms. Feeding and breathing methods can influence the frequency and type of aerodigestive symptoms.
GERD treatments should be individualized to the patient’s GERD phenotype and likely also target the bolus component of GER.]]></description><subject>Acids</subject><subject>Clinical Research Article</subject><subject>Cough</subject><subject>Critical Care</subject><subject>Electric Impedance</subject><subject>Enteral Nutrition</subject><subject>Esophagus</subject><subject>Esophagus - metabolism</subject><subject>Esophagus - pathology</subject><subject>Female</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - pathology</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Infant</subject><subject>Infant, Premature - physiology</subject><subject>Intensive Care Units</subject><subject>Intensive Care Units, Neonatal</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multivariate Analysis</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Phenotype</subject><subject>Probability</subject><subject>Sensitivity and Specificity</subject><issn>0031-3998</issn><issn>1530-0447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kc9u1DAQxiMEokvhAbggS1y4BOzY8Z8LEiqFIlXiAmfL60yyrhI72M6qe-Md-oY8SR1tKQUJyZYtz2--Gc9XVS8Jfkswle8SI1ThGjdlK4pr_qjakLZcMGPicbXBmJKaKiVPqmcpXWFMWCvZ0-qENlS0hDeb6uaj63uI4LMz2fkBQQrzzgxgRpTAJ5fd3uUDmnfgQz7MkNCSVm6--PXzxk0zdMZbQM6XldeEPSBrIqDFu1zeeuNzQhFKkQgd6kNEg0k5hgeFSnRcrlE6THMOU3pePenNmODF3Xlaff90_u3sor78-vnL2YfL2jKBc92ZLWeWAeWSbRWjneyJ3CrRG0utbDiXihpm2wYM4RIEU30rur4RArgRnNPT6v1Rd162E3S2DCGaUc_RTSYedDBO_x3xbqeHsNeCM9aqVeDNnUAMPxZIWU8uWRhH4yEsSTfr7KnkVBX09T_oVViiL9_TTYspZkLxlSJHysaQUhnLfTME69VyfbRcF8v1arlem3j18Bf3Gb89LkBzBFIJ-QHin9L_V70FTxG9LA</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Jadcherla, Sudarshan R.</creator><creator>Sultana, Zakia</creator><creator>Hasenstab-Kenney, Kathryn A.</creator><creator>Prabhakar, Varsha</creator><creator>Gulati, Ish K.</creator><creator>Di Lorenzo, Carlo</creator><general>Nature Publishing Group US</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210201</creationdate><title>Differentiating esophageal sensitivity phenotypes using pH–impedance in intensive care unit infants referred for gastroesophageal reflux symptoms</title><author>Jadcherla, Sudarshan R. ; Sultana, Zakia ; Hasenstab-Kenney, Kathryn A. ; Prabhakar, Varsha ; Gulati, Ish K. ; Di Lorenzo, Carlo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-dab64c4e3684b943d8f18b97fac3c8266893a4c52ea168e749f57df277e6a7663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acids</topic><topic>Clinical Research Article</topic><topic>Cough</topic><topic>Critical Care</topic><topic>Electric Impedance</topic><topic>Enteral Nutrition</topic><topic>Esophagus</topic><topic>Esophagus - metabolism</topic><topic>Esophagus - pathology</topic><topic>Female</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - pathology</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Infant</topic><topic>Infant, Premature - physiology</topic><topic>Intensive Care Units</topic><topic>Intensive Care Units, Neonatal</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multivariate Analysis</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Phenotype</topic><topic>Probability</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jadcherla, Sudarshan R.</creatorcontrib><creatorcontrib>Sultana, Zakia</creatorcontrib><creatorcontrib>Hasenstab-Kenney, Kathryn A.</creatorcontrib><creatorcontrib>Prabhakar, Varsha</creatorcontrib><creatorcontrib>Gulati, Ish K.</creatorcontrib><creatorcontrib>Di Lorenzo, Carlo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jadcherla, Sudarshan R.</au><au>Sultana, Zakia</au><au>Hasenstab-Kenney, Kathryn A.</au><au>Prabhakar, Varsha</au><au>Gulati, Ish K.</au><au>Di Lorenzo, Carlo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differentiating esophageal sensitivity phenotypes using pH–impedance in intensive care unit infants referred for gastroesophageal reflux symptoms</atitle><jtitle>Pediatric research</jtitle><stitle>Pediatr Res</stitle><addtitle>Pediatr Res</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>89</volume><issue>3</issue><spage>636</spage><epage>644</epage><pages>636-644</pages><issn>0031-3998</issn><eissn>1530-0447</eissn><abstract><![CDATA[Background
To identify esophageal sensitivity phenotypes relative to acid (S
Acid
), bolus (S
Bolus
), acid and bolus (S
Acid+Bolus
), and none (S
None
) exposures in infants suspected with gastroesophageal reflux disease (GERD).
Methods
Symptomatic infants (
N
= 279) were evaluated for GERD at 42 (40–45) weeks postmenstrual age using 24-h pH–impedance. Symptom-associated probability (SAP) for acid and bolus components defined esophageal sensitivity: (1) S
Acid
as SAP ≥ 95% for acid (pH < 4), (2) S
Bolus
as SAP ≥ 95% for bolus, (3) S
Acid+Bolus
as SAP ≥ 95% for acid and bolus, or (4) S
None
as SAP < 95% for acid and bolus.
Results
Esophageal sensitivity prevalence (S
Acid
, S
Bolus
, S
Acid+Bolus
, S
None
) was 28 (10%), 94 (34%), 65 (23%), and 92 (33%), respectively. Emesis occurred more in S
Bolus
and S
Acid+Bolus
vs S
None
(
p
< 0.05). Magnitude (#/day) of cough and emesis events increased with S
Bolus
and S
Acid+Bolus
vs S
None
(
p
< 0.05). S
Acid+Bolus
had increased acid exposure vs S
None
(
p
< 0.05). Distributions of feeding and breathing methods were distinct in infants with S
Bolus
vs S
None
(both,
p
< 0.05). Multivariate analysis revealed that arching and irritability events/day were lesser at higher PMAs (
p
< 0.001) and greater for infants on NCPAP (
p
< 0.01) with S
Bolus
and S
Acid+Bolus
(
p
< 0.05). Coughs/day was greater at higher PMAs (
p
< 0.001) for infants with gavage and transitional feeding methods (
p
< 0.02) with S
Bolus
and S
Acid+Bolus
(
p
< 0.05) but lesser with Trach (
p
< 0.001). Number of emesis events/day were greater with S
Bolus
and S
Acid+Bolus
(
p
< 0.001). Sneezes/day decreased for infants on Trach (
p
= 0.02).
Conclusions
Feeding and breathing methods can influence the frequency and type of aerodigestive symptoms. We differentiated esophageal sensitivity phenotypes in NICU infants referred for GERD symptoms using pH–impedance. Acid sensitivity alone was rare, which may explain poor response to acid suppressives; aerodigestive symptoms were predominantly linked with bolus spread. Magnitude of esophageal acid exposure and esophageal sensitivity to bolus spread may explain the pathophysiological basis for symptoms.
Impact
Objective GERD diagnosis and reasons for symptoms in NICU infants remains unclear.
Differentiation of esophageal sensitivities by acid and bolus components of GER reveal distinct symptom profiles, specifically the bolus component of GER significantly contributes to symptom occurrence.
Acid only sensitivity to GER is rare, and acid-suppressive therapy alone may not improve symptoms in a majority of NICU infants.
Magnitude of esophageal acid exposure and esophageal sensitivity to any bolus spread may explain the pathophysiological basis for symptoms. Feeding and breathing methods can influence the frequency and type of aerodigestive symptoms.
GERD treatments should be individualized to the patient’s GERD phenotype and likely also target the bolus component of GER.]]></abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>32375162</pmid><doi>10.1038/s41390-020-0930-6</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0031-3998 |
| ispartof | Pediatric research, 2021-02, Vol.89 (3), p.636-644 |
| issn | 0031-3998 1530-0447 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7644596 |
| source | Springer Nature |
| subjects | Acids Clinical Research Article Cough Critical Care Electric Impedance Enteral Nutrition Esophagus Esophagus - metabolism Esophagus - pathology Female Gastroesophageal reflux Gastroesophageal Reflux - pathology Humans Hydrogen-Ion Concentration Infant Infant, Premature - physiology Intensive Care Units Intensive Care Units, Neonatal Male Medicine Medicine & Public Health Multivariate Analysis Pediatric Surgery Pediatrics Phenotype Probability Sensitivity and Specificity |
| title | Differentiating esophageal sensitivity phenotypes using pH–impedance in intensive care unit infants referred for gastroesophageal reflux symptoms |
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