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Published on: February 26, 2021
Anti-reflux surgery for the neonatal intensive care-dependent infant
N Barnes1, N Robertson, K Lakhoo
1Department of Neonatology, Imperial College School of Medicine, Hammersmith Campus, London W12 0HS, UK.
Insights
Nissen fundoplication is a safe and effective surgery for infants with severe gastro-oesophageal reflux (GOR) unresponsive to medical treatment. This anti-reflux surgery also aids in palliative enteral feeding for infants with life-limiting conditions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Gastro-oesophageal reflux (GOR) in infants can lead to severe complications, including life-threatening respiratory issues.
- The efficacy of anti-reflux surgery for GOR in neonates remains uncertain, particularly in cases unresponsive to medical management.
Purpose of the Study:
- To evaluate the effectiveness and safety of Nissen fundoplication for severe GOR in infants.
- To assess the role of Nissen fundoplication in facilitating enteral feeding in this population.
Main Methods:
- Nissen fundoplication was performed on 10 neonatal intensive care-dependent infants with severe GOR refractory to medical treatment.
- Outcomes including intra-operative events, post-operative feeding success, respiratory support, and mortality were compared pre- and post-surgery.
- Median follow-up was 14 months.
Main Results:
- No intra-operative complications or mortality occurred.
- Eight of nine surviving infants were discharged following successful enteral feeding.
- While some infants experienced complications like gastrostomy site infection or required tube replacement, all survivors were thriving at follow-up.
Conclusions:
- Nissen fundoplication is a feasible, effective, and safe surgical option for infants with severe GOR unresponsive to medical therapy.
- The procedure plays a crucial role in enabling safe palliative enteral feeding for infants with conditions incompatible with long-term survival.
Aim:
The benefit of anti-reflux surgery for gastro-oesophageal reflux (GOR) in early infancy is uncertain. The aim of this study was to assess the value of Nissen fundoplication in a group of infants with severe GOR.
Methods:
10 infants underwent Nissen fundoplication for gastro-oesophageal reflux following a failure of medical management. All had suffered life-threatening respiratory episodes as a consequence of gastro-oesophageal reflux, and were neonatal intensive care-dependent. Median (range) birth weight was 1.26 kg (0.48-3.8 kg), gestation 30 weeks (25-38 weeks); at surgery, weight was 3.25 kg (2.5-6.1 kg) at a corrected age of 11.5 weeks (term-22) weeks. For each infant, the success of enteral feeding and the level of support required pre- and post-operatively was compared, and where appropriate, the facilitation of palliative feeding was assessed. Median follow-up was 14 (3-36) months.
Results:
No infant suffered intra-operative morbidity or mortality. One infant died within 1 month of surgery from a collapse unrelated to surgery. Eight of nine surviving infants were discharged from intensive care following extubation and the establishment of enteral feeding. One patient died of severe bronchopulmonary dysplasia 3 months post-surgery. One infant developed a gastrostomy site infection, and two required gastrostomy tube replacement within 6 months of surgery. All were thriving at follow-up. Two infants with a congenital myopathy died as a result of their muscle disease at 9 and 11 months post-operatively.
Conclusions:
Nissen fundoplication is a feasible, effective and safe operation in severe gastro-oesophageal reflux unresponsive to medical treatment in term and pre-term infants. It has an additional important role in facilitating safe palliative enteral feeding in infants with a diagnosis incompatible with survival into adulthood.
