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[Esophageal pH measurements in newborn infants. Value and indications]
Insights
Esophageal pH monitoring is a reliable diagnostic tool for gastroesophageal reflux (GER) in newborns. This test accurately identifies GER, even with atypical symptoms, aiding in timely infant care.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Medicine
Background:
- Gastroesophageal reflux (GER) is common in infants and children.
- Clinical presentation of GER in newborns can be difficult to correlate with the condition.
- Esophageal pH monitoring is considered the most reliable diagnostic test for GER.
Purpose of the Study:
- To validate the efficacy of 18-24 hour esophageal pH monitoring for diagnosing GER in newborns.
- To assess the correlation between clinical presentation and pH monitoring results in infants.
- To establish discriminative values for esophageal pH monitoring in the neonatal population.
Main Methods:
- 18-24 hour esophageal pH monitoring was performed on 26 newborns.
- 19 infants with suspected GER underwent pH monitoring.
- 7 control infants were monitored for comparison.
- Comparison with other diagnostic investigations like barium esophagram, scintigraphy, and esophagoscopy was performed.
Main Results:
- Esophageal pH monitoring positively diagnosed GER in 12 out of 19 infants with suspected GER.
- In 7 of these infants, other investigations confirmed GER in only 4 cases.
- For control infants, the percentage of monitoring time with pH below 4.0 (upper limit: 4.2%) proved to be a strong discriminative value for GER diagnosis.
- Unusual neonatal GER symptoms include apneic spells, dyspnea, cyanosis, and neurological signs, indicating the need for pH monitoring.
Conclusions:
- Esophageal pH monitoring is a validated and reliable method for diagnosing GER in newborns.
- The test demonstrates superior diagnostic accuracy compared to other investigations for GER in this age group.
- Esophageal pH monitoring is recommended for neonates presenting with atypical symptoms suggestive of GER.
Abstract:
Esophageal pH monitoring is now the most reliable test in the diagnosis of gastroesophageal reflux (GER) in infants and children. A 18-24 hr esophageal pH monitoring is undertaken in 26 newborns to validate this test for this age group where GER is frequent with fair correlation of clinical presentation. In 19 infants with suspicion of GER, this test give a positive diagnosis in 12 of them. Seven out of these 12 infants have another investigations (barium- esophagram - scintigraphy - esophagoscopy) with only a positive diagnosis of GER in 4 cases. Esophageal pH monitoring in 7 control infants show that the percent of monitoring time with pH below 4.0 is one of the best discriminative values (upper limit: 4.2%) for the diagnosis of GER. Unusual symptoms of GER in the neonatal period as apneic spells, dyspnea, cyanosis or neurological signs are indications for esophageal pH monitoring.