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Updated: Jun 17, 2026
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Published on: December 14, 2020
Pediatric specialists' beliefs about gastroesophageal reflux disease in premature infants
Catherine A Golski1, Ellen S Rome, Richard J Martin
1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA. golskic@email.chop.edu
Insights
Physician beliefs on diagnosing and treating gastroesophageal reflux disease (GERD) in premature infants vary widely by specialty and do not align with scientific evidence. A consistent standard of care for infant GERD is needed.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Pediatric Pulmonology
Background:
- Significant variation exists in managing suspected gastroesophageal reflux disease (GERD) in premature infants.
- The influence of physician specialty and interpretation of medical literature on GERD diagnosis and treatment remains unclear.
Purpose of the Study:
- To investigate the impact of medical specialty and literature interpretation on the diagnosis and treatment of GERD in premature infants.
- To assess the beliefs of neonatologists, pediatric pulmonologists, and pediatric gastroenterologists regarding GERD management.
Main Methods:
- An online survey was administered to board-certified neonatologists, pediatric pulmonologists, and pediatric gastroenterologists.
- Participants were queried on their beliefs about GERD symptoms, diagnosis, and treatment in premature infants within the NICU, considering both clinical impression and literature review.
Main Results:
- Disagreement among specialists was prevalent across nearly all aspects of GERD management.
- Pulmonologists were more likely to attribute respiratory symptoms to GERD, while neonatologists were less likely to find pharmacologic trials or specific medications (lansoprazole, ranitidine, cimetidine) safe or effective.
- Physician beliefs showed moderate correlation with both clinical impression and literature interpretation, yet did not appear driven by the strength of evidence in neonatal literature.
Conclusions:
- Wide variation exists among pediatric specialists concerning GERD beliefs in premature infants and the interpretation of supporting medical literature.
- Physician beliefs regarding GERD in premature infants are not consistently aligned with the available evidence in the neonatal literature.
- The lack of a standardized care approach for infant GERD necessitates further research into how physicians form clinical judgments and apply evidence to patient care.
Background:
Wide variation exists in the treatment of suspected gastroesophageal reflux disease (GERD) in premature infants; it is unknown to what degree diagnosis and treatment are affected by the treating physician's medical specialty or interpretation of the medical literature.
Methods:
This study involved an online survey of board-certified neonatologists, pediatric pulmonologists, and pediatric gastroenterologists about their beliefs regarding the symptoms, diagnosis, and treatment of GERD in premature infants in the NICU on the basis of both clinical impression and interpretation of the literature.
Results:
A total of 1021 neonatologists, 232 pediatric pulmonologists, and 222 pediatric gastroenterologists participated in the study (47.5% response rate). There was disagreement among specialists in nearly all aspects of the survey. Pulmonologists were most likely to report that respiratory symptoms are caused by GERD (P < .001). Neonatologists were least likely to report that a therapeutic trial of pharmacologic agents would be useful for diagnosing GERD (P < .001) or that lansoprazole, ranitidine, or cimetidine are safe or effective (P < .001). No pharmacologic therapy had >50% of respondents supporting its effectiveness. There was moderate correlation between physician belief based on the medical literature and belief based on clinical impression (Spearman rank correlation: 0.47-0.75). For therapies supported by multiple meta-analyses in infants versus therapies with few infant trials, physicians rated the evidence for effectiveness similarly.
Conclusions:
There is wide variation among pediatric specialists regarding beliefs about GERD in premature infants, as well as about the weight of evidence in the medical literature for this patient population. Physician beliefs do not seem to be driven by the degree of evidence in the neonatal literature. With no agreed-on standard of care in the setting of widespread use of antireflux medications, greater understanding is needed about the ways physicians form clinical impressions, access and process medical evidence, and apply it to patient care.
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