Gastroesophageal Reflux in Preterm Infants: Diagnosis and Management

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GER is common in preterm infants and can occur multiple times in a day.
GER is common in preterm infants and can occur multiple times in a day.

The American Academy of Pediatrics has updated its list of gastroesophageal reflux (GER) diagnosis and management recommendations for preterm infants, according to a clinical report published in Pediatrics.

Eric C. Eichenwald, MD, FAAP, lead author of the report and AAP Committee on Fetus and Newborn member, consolidated reports from several studies, which highlight the following:

  • Intolerance or aversion to feeding, poor weight gain, repeated regurgitation, apnea, desaturation, bradycardia, irritability, and perceived postprandial discomfort are commonly recognized as outcomes of GER.
  • Data dissociate these apparent outcomes of GER with acidic and nonacidic reflux episodes, as measured by multichannel intraesophageal impedance/pH; associated signs commonly improve without the need for treatment.
  • Pharmacologic agents, frequently used to treat preterm infants with clinically diagnosed GER, are linked to harmful events (including gastric acid blockade) and lack significant efficacy. The studies strongly urge clinicians to refrain or sparingly use such agents in preterm infants.
  • Head elevation, more frequent but smaller feeding volumes with thickened formula, and left lateral placement of the infant, as well as similar nonpharmacologic measures to reduce reflux have not been proven to reduce clinically reported signs of GER in preterm infants.
  • Safe sleep recommendations, such as avoidance of elevation of the infant's head in the crib, should be demonstrated for parents prior to hospital discharge.

Dr Eichenwald concluded by advising that “the clinical report should help guide clinicians to ‘just say no' to the treatment of GER in the [neonatal intensive care unit].”

Reference

Eichenwald EC. Gastroesophageal reflux in preterm infants: guidance on diagnosis, management. [clinical report]. AAP News. Accessed: June 18, 2018. Accessible at: http://www.aappublications.org/news/2018/06/18/reflux061818

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