Postprandial gastroesophageal reflux (GER) in premature infants is increased when infants are placed in the right lateral or supine positions, according to the results of two studies appearing in the Journal of Pediatrics for December.

Nonetheless, placing infants on the right side for 1 hour after feeding and then switching to the left side position may actually achieve the best gastric emptying, Dr. Michiel P. van Wijk, from the Academic Medical Centre in Amsterdam, the Netherlands, and colleagues report.

In their study, Dr. van Wijk's team used standard monitoring and esophageal impedance-manometry to assess GER in 10 healthy preterm infants who were gavage-fed. The infants were placed in either the right- or left-lateral position for the first hour after feeding and then switched to the opposite position for the second hour.

Initially, liquid GER was significantly greater with the right-side down position (p = 0.002). However, starting with this position first and then switching to the left-side down position actually resulted in fewer GER episodes in the subsequent hours than did the opposite positioning sequence.

Further analysis showed that gastric emptying was also enhanced with the right-side down first protocol (p = 0.006).

In the second study, Dr. Luigi Corvaglia, from Istituto di Pediatria Preventiva e Neonatologia in Bolgna, Italy, and colleagues used 24-hour intraluminal pH monitoring to assess GER in 22 premature infants with frequent regurgitation and postprandial desaturation. GER was evaluated during four postprandial positions: supine, prone, right-side down, left-side down.

The authors found that GER was greatest in the right side and supine positions. They also found that nonacid GER episodes decreased with time since feeding, while acid GER episodes increased.

Esophageal acid exposure in the early and late postprandial periods was lowest with the left-side down and prone positions, respectively, the report indicates.

"The potential benefit of these positioning strategies in inpatient preterm infants will need to be balanced against the risk of undermining the 'back to sleep' (anti-SIDS) message as families prepare to take their infants home," Dr. Richard J. Martin and colleagues, from Rainbow Babies and Children's Hospital in Cleveland, comment in a related editorial.