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Behavior and gastroesophageal reflux in the premature neonate
A Snel1, C P Barnett, T L Cresp
1Neonatal Medicine Unit, Women's and Children's Hospital, North Adelaide, SA, Australia.
Insights
Behavioral signs in premature infants do not reliably indicate gastroesophageal reflux (GER) episodes. Current diagnostic criteria for GER in neonates may require reevaluation to avoid unnecessary treatments.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Developmental Pediatrics
Background:
- Gastroesophageal reflux (GER) is common in premature infants.
- Clinical diagnosis of GER often relies on behavioral observations.
- The diagnostic utility of behavioral signs for GER in neonates lacks formal validation.
Purpose of the Study:
- To investigate the association between esophageal acidification and specific behavioral changes in premature neonates.
- To determine if recognized reflux-associated behaviors in term infants are present and linked to GER in premature infants.
Main Methods:
- Simultaneous video recording and esophageal pH monitoring in 14 healthy premature infants.
- Analysis of 20 documented acid GER episodes.
- Scoring of general and reflux-specific behaviors by independent observers during reflux events.
Main Results:
- Esophageal acidification did not significantly alter general infant behavior scores.
- While reflux-specific behaviors (e.g., discomfort, head retraction) were observed, they were not consistently linked to acid GER episodes.
- No temporal association was found between observed behaviors and documented GER events.
Conclusions:
- Behavioral criteria for GER established in term infants may not be appropriate for premature neonates.
- Relying on these behavioral signs could lead to misdiagnosis and inappropriate antireflux therapy in premature infants.
Background:
The belief that behavioral observations assist in the clinical diagnosis of gastroesophageal reflux (GER) disease in premature neonates has not been formally tested. The purpose of this study was to determine whether esophageal acidification was associated with a recognizable pattern of behavioral changes in these infants.
Methods:
The behavior of 14 healthy premature infants was recorded by a video camera while esophageal pH was simultaneously monitored. For each of 20 acid GER episodes recorded, a 10-minute video epoch, encompassing the onset of acid GER and lasting at least 4 minutes after the onset of GER, was examined. Two independent observers each scored reflux-associated epochs of "general" infant behavior and behavior previously shown to be indicative of reflux in normal term infants.
Results:
The occurrence of esophageal acidification due to reflux did not significantly alter scores for general behavior. Infants frequently demonstrated reflux-specific behavior, including discomfort, head retraction, and mouthing; however, none of these behavioral patterns was temporally associated with the occurrence of acid GER.
Conclusions:
These data indicate that reflux-specific behavioral criteria, established in older term infants, may be inappropriate as diagnostic criteria for GER in premature neonates and may lead to the unnecessary use of antireflux therapy.