NeoNotes
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Andrew
B. Kairalla MD, Editor
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GE Reflux in Preemies
Gastroesophageal Reflux: A Critical Review of Its Role in Preterm Infants. Poets CF, Pediatrics (Feb 2004) 113: e150-e152.
There is widespread
concern about gastroesophageal reflux (GER) in preterm infants.
This article reviews the evidence for this concern. GER is common
in infants, which is related to their large fluid intake
(corresponding to 14 L/day in an adult) and supine body position,
resulting in the gastroesophageal junction’s being constantly
"under water." pH monitoring, the standard for reflux detection, is
of limited use in preterm infants whose gastric pH is >4 for 90% of
the time. New methods such as the multiple intraluminal impedance
technique and micromanometric catheters may be promising
alternatives but require careful evaluation before applying them to
clinical practice. A critical review of the evidence for potential
sequelae of GER in preterm infants shows that 1) apnea is unrelated
to GER in most infants, 2) failure to thrive practically does not
occur with GER, and 3) a relationship between GER and chronic
airway problems has not yet been confirmed in preterm infants.
Thus, there is currently insufficient evidence to justify the
apparently widespread practice of treating GER in infants with
symptoms such as recurrent apnea or regurgitation or of prolonging
their hospital stay, unless there is unequivocal evidence of
complications, e.g., recurrent aspiration or cyanosis during
vomiting. Objective criteria that help to identify those presumably
few infants who do require treatment for GER disease are urgently
needed.
Comment: I suspect that GER is one of the most over-diagnosed and over-treated conditions in premature babies. The fact is that almost all premature babies (and probably most term babies) have some degree of GE reflux that you will be able to demonstrate if you look hard enough. This reflux is usually not the cause of the apnea, bradycardia or desaturation episodes that we frequently see in premature babies. Treating the reflux with medications that block release of stomach acids may interfere with digestion, and may predispose to fungal infections. The use of prokinetic agents (such as metoclopramide) to improve GI motility and reduce feeding intolerance may be helpful in some premature infants with or without GE reflux. ABK
Date: 16 Mar 2004
Time: 07:53:48
I think GER may very well be over treated with the "well" premie growers.
However, there is a population of premies who are more vulnerable to the effects
of GERD with an association of CLD and failure to thrive. This is much more
evident after discharge from the NICU when the babies become more orally
aversive and refuse feedings. The newborn follow-up clinics, pulmonologists and
private pediatricians are the ones who then manage the consequences of unchecked
GERD. The data for failure to thrive associated with GERD is available for the
older discharged premie. It is understandable that the problem is not as evident
while still in the NICU with their intake being closely monitored and
supplemented as needed.
UserName: Donna Watkins RNC, MSN, NNP
Institution: Riley Hospital For Children
telephone: 317-274-4817
email: dwatkins@iupui.edu
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