2.1 | Imaging techniques
Gastric emptying was assessed using 2 methods at a time when infants
were receiving at least 120 mL/kg/day of enteral feedings and no
intravenous fluids. The first method is to calculate the maximum antral
cross-sectional area (ACSA) by measuring the longest anteroposterior and
transverse diameters of the gastric antrum by real-time US (Zonare,
Mindray, Shenzhen, China) [8]. The second method is to calculate the
spheroid gastric volume by measuring the largest anteroposterior,
longitudinal and transverse diameters of the stomach filled with milk
with the US transducer positioned on the lower left lateral chest and
upper abdomen [9,10]. Each infant had a total of 4 measurement
points: before feeding (0 hour), at 1 hour, 2 hours and 3 hours after
the initiation of the feeding (Figure 1 ). Infants were
kept in a flat supine position during the study period. Based on the
consecutive measurements, ACSAs and spheroid volumes were used to
calculate percent change in ACSA and percent change in spheroid gastric
volume between two consecutive feedings as proxies for percentage of
milk emptied per minute. Early gastric emptying was defined as the
change in volume determination from 1 hour to 2 hours after the
initiation of the feeding. Late gastric emptying defined as the change
in volume from 2 hours to 3 hours after the initiation of the feeding.
Values obtained by both US methods were compared between the two modes
of CPAP.
Gastric residual volume percentage was calculated by dividing the
gastric volume at 1 hour (immediately prior to the next feeding) by the
gastric volume at 1 hour (after completion of the study feeding). Value
obtained was expressed as a percentage.
A lung ultrasound score (LUS) was also determined at the 1-hour
measurement point in order to ensure that the CPAP groups did not differ
in the severity of their respiratory disease. The LUS score is assigned
based on observations reflecting the efficacy of aeration at 6 different
lung fields [12]. A recent meta-analysis has validated it for
assessing the severity of RDS with high sensitivity and specificity
[11].
Ultrasound gel was prewarmed and transducer sanitized before each exam.
During the exam, infants were comforted with a pacifier. If an infant
had oxygen desaturation below 80% or bradycardia below 80 bpm, the exam
was stopped to allow the infant to recover. No sedation was used during
the US exams.