Related Experiment Video
Updated: Jun 27, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED)
Greta Carabelli1, Ivan Binotto1, Chiara Armano1
1Pediatric Department, "F. Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy.
Insights
Empirical acid suppressant treatment for infant crying is not supported by evidence. Gastroesophageal reflux (GER) is not consistently indicated in infants with unexplained persistent crying, even with nocturnal symptoms.
Area of Science:
- Pediatrics
- Gastroenterology
- Infant Health
Background:
- Nocturnal infant crying is frequently managed with acid suppressants.
- The study investigates the prevalence and characteristics of gastroesophageal reflux (GER) in infants experiencing unexplained persistent crying.
Purpose of the Study:
- To evaluate the prevalence and characteristics of GER in infants with unexplained persistent crying.
- To determine if empirical acid suppressant treatment is justified for such cases.
Main Methods:
- Esophageal impedance-pH monitoring (MII-pH) was used in infants (0-12 months) with unexplained persistent crying.
- Exclusion criteria included gastrointestinal malformations, neurological impairment, and infections.
- Data analyzed included GER symptoms, I-GERQ-R scores, and MII-pH results.
Main Results:
- 60% of infants with persistent crying had normal MII-pH findings.
- Nocturnal crying was present in 52% of infants, with normal MII-pH in 54% of these cases.
- Neither I-GERQ-R scores nor regurgitation frequency predicted abnormal MII-pH results.
Conclusions:
- Empirical treatment with acid inhibitors is not recommended for infants with persistent unexplained crying.
- GER is not consistently identified as the cause of unexplained persistent or nocturnal infant crying.
Background:
Nocturnal infant crying is often empirically treated with acid suppressants. The aim of this study was to evaluate the prevalence and characteristics of gastroesophageal reflux (GER) in infants with unexplained persistent crying.
Methods:
We enrolled all infants (0-12 months) referred for suspected GER disease who underwent esophageal impedance-pH monitoring (MII-pH) for unexplained persistent crying not improved by parental reassurance, dietary modification or alginate. Gastrointestinal malformation/surgery, neurological impairment and infections were exclusion criteria. Demographic and anthropometric parameters, GER symptoms and questionnaires (I-GERQ-R) and MII-pH data were recorded and analyzed. Normal MII-pH was defined when acid exposure was <3%, symptom index was <50% and symptom association probability was <95%. Acid exposure >5% and >10% was also considered. Statistical analysis was performed using Chi-Square and univariate and multivariable regression analysis.
Results:
We included 50 infants (median age 3.5 months) who fulfilled the study criteria: 30 (60%) had normal MII-pH. I-GERQ-R score was abnormal in 33 (66%) infants, and 21/33 (64%) had normal MII-pH (p = 0.47). In the 26 (52%) infants with nocturnal crying, MII-pH was normal in 16 (54%) (p = 0.82). Associated regurgitation (>3 or >10 episodes/die) did not predict abnormal MII-pH (p = 0.74, p = 0.82, respectively). Univariate and multivariable regression analysis did not identify any clinical variable significantly associated with abnormal MII-pH.
Conclusions:
Infants with persistent unexplained and nocturnal crying should not be empirically treated with acid inhibitors.
Related Concept Videos
01:18Nightmares and Night Terrors
Nightmares...
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...