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Gastroesophageal reflux and the premature infant
Insights
Gastroesophageal reflux (GER) in premature infants, especially those with bronchopulmonary dysplasia (BPD), often requires surgical intervention. Prompt evaluation for GER is crucial in preterm infants experiencing pulmonary decline or feeding issues.
Area of Science:
- Neonatology
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) is common in infants and children, but underrecognized in premature infants.
- Bronchopulmonary dysplasia (BPD) is a significant predisposing factor for severe GER in preterm infants.
Purpose of the Study:
- To investigate the incidence and management of GER in premature infants admitted to a NICU.
- To determine the relationship between BPD and the severity of GER in this population.
Main Methods:
- Retrospective review of 760 preterm infants admitted to the NICU between 1980 and 1984.
- Analysis of infants with documented GER, their medical and surgical management, and outcomes.
- Comparison of GER incidence and management in infants with and without BPD.
Main Results:
- 22 out of 760 preterm infants had documented GER.
- 14 out of 76 infants with BPD (18.4%) had significant GER requiring surgical management.
- 17 infants underwent fundoplication, with 15 having been intubated for respiratory distress syndrome.
- Fundoplication significantly improved pulmonary status in most infants.
- GER was associated with pulmonary deterioration, failure to grow, and feeding refusal in preterm infants.
Conclusions:
- Premature infants with BPD have a higher incidence of significant GER requiring surgical intervention.
- Deteriorating pulmonary function, poor growth, or feeding refusal in preterm infants warrants evaluation for GER.
- Surgical management, such as fundoplication, can be effective in controlling severe GER in this population.
Abstract:
Gastroesophageal reflux (GER) is a well-recognized problem in infants and children. Only scant mention of the premature infant with GER can be found in the literature. Of 760 preterm infants admitted to the NICU between 1980 and 1984, 22 had documented GER. These infants all underwent medical management including upright positioning, small frequent feeds, and often, nasojejunal feedings. Seventeen babies did not respond to medical management and underwent surgical therapy to control the reflux. Of the 17 babies requiring fundoplication, 15 had been initially intubated for treatment of respiratory distress syndrome. Eight of these 15 were extubated in less than 25 days and were improving until they exhibited sudden episodes of deteriorating pulmonary status requiring reintubation. The other seven intubated patients developed striking bronchopulmonary dysplasia (BPD) in the first month and required prolonged ventilatory support. Pulmonary deterioration, failure to grow, and refusal to eat became the herald of GER in these infants. Fundoplication dramatically improved the pulmonary status in all but one infant. Three late deaths can be attributed to cor pulmonale and pulmonary failure. BPD was striking predisposing factor for severe GER in these premature infants. In the total premature population without BDP only 8 of 684 (1.2%) had GER with five responding to medical management and three others undergoing fundoplication for apnea-bradycardia spells. Fourteen of the 76 infants with BPD (18.4%) had significant GER and all required surgical management for control of symptoms. Premature infants who develop deteriorating pulmonary function, poor growth, and/or refusal to eat should be evaluated for GER.