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The Irritable Infant in the Neonatal Intensive Care Unit: Risk Factors and Biomarkers of Gastroesophageal Reflux
Minna Njeh1, Roseanna Helmick1, Enas Alshaikh1
1Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH.
Insights
Gastroesophageal reflux (GER) is unlikely to cause arching/irritability in high-risk infants. Preterm birth and neurological issues are more probable causes, suggesting empiric GER treatment is not advised.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Research
Background:
- Infants in neonatal intensive care units (NICU) often exhibit arching and irritability.
- Gastroesophageal reflux (GER) is frequently suspected as a cause, but its role in these symptoms requires further investigation.
Purpose of the Study:
- To identify risk factors associated with arching/irritability in high-risk infants.
- To evaluate the contribution of comorbidities and specific GER characteristics to these symptoms.
Main Methods:
- A retrospective analysis of 24-hour pH-impedance studies was performed on 516 symptomatic infants in the NICU.
- Infants were categorized based on the daily frequency of arching/irritability events (>72 vs <=72).
- Risk factors and clinical correlates were analyzed, adjusting for postmenstrual age and weight.
Main Results:
- No significant differences in acid reflux or impedance bolus characteristics were found between infants with high (>72) versus low (<=72) daily arching/irritability events.
- Significant risk factors for arching/irritability included preterm birth (OR 2.3), moderate/severe neuropathology (OR 2.0), and oral feeding at testing (OR 1.57).
Conclusions:
- Acid GER disease is unlikely the primary driver of arching/irritability in this population.
- Prematurity and neurological impairment are more probable causes.
- Empiric GER treatment is not recommended for arching/irritability, and the symptom may be less concerning in orally fed infants.
Objectives:
To determine risk factors for arching/irritability in high-risk infants and examine the significance of comorbidity and gastroesophageal reflux (GER) characteristics.
Study Design:
Retrospective analysis of 24-hour pH-impedance studies of symptomatic infants in a neonatal intensive care unit (ICU) (n = 516, 30.1 ± 4.5 weeks of gestation, evaluated at 41.7 ± 3.2 weeks postmenstrual age) was conducted. Comparisons were made between infants with >72 vs ≤72 arching/irritability events per day. We characterized risk factors for arching/irritability along with clinical, pH-impedance, and outcome correlates.
Results:
Of 39 973 arching/irritability events and 42 155 GER events, the averages per day were 77.6 ± 41.0 and 81.7 ± 48.2, respectively. Acid reflux and impedance bolus characteristics were not significantly different between infants with >72 and ≤72 arching/irritability events (P ≥ .05). The odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for postmenstrual age and weight at evaluation were significant for risk factors of preterm birth (2.3 [1.2-4.4]), moderate or severe neuropathology (2.0 [1.1-3.6]), and presence of oral feeding at testing (1.57 [1.07-2.30]).
Conclusions:
Acid GER disease is unlikely the primary cause of arching/irritability and empiric treatment should not be used when arching/irritability is present. Prematurity and neurologic impairment may be more likely the cause of the arching/irritability. Arching/irritability may not be a concern in orally fed infants.
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